Association Between Acute Kidney Disease and Intravenous Dye Administration in Patients With Acute Stroke

Abstract

Background and Purpose CT angiography (CTA) and conventional angiography provide timely vascular anatomical information in stroke patients. However, iodinated contrast dye may cause acute kidney injury (AKI). Within a large, biracial population, we examined in-hospital incidence of new or worsening kidney disease in stroke patients and its association with administration of intravenous (IV) dye. Methods All adult residents of the Greater Cincinnati/Northern Kentucky (GCNK) region with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH) who presented to an emergency department in 2010 were included. Prevalence of unsuspected kidney disease at the time of ED presentation was determined as well as incidence of AKI after admission in two groups of patients – those who did and those who did not receive IV dye. Results In 2010, 2299 patients met inclusion criteria (89% IS, 11% ICH); mean age 69 years (SD 15), 22% black, 54% women. Among these patients, 37% had kidney disease at baseline, including 22% (516/2299) in whom this was unsuspected. Two percent (2%; 15/853) of patients with baseline kidney disease developed AKI during the hospital stay. Of those with no baseline kidney disease, 1% (14/14467) developed AKI. There was no association between dye administration and new or worsening kidney disease. Conclusions Although 22% of patients in the GCNK stroke population had unsuspected kidney disease, the incidence of new or worsening kidney disease was low, and AKI was not associated with dye administration. These findings confirm single-center reports that the risk of severe renal complications after contrast dye is small.

Repeated mechanical thrombectomy for acute ischemic stroke in a dialysis patient: A case report and literature review

“…21 In fact, the use of CM during imaging is the third most common trigger for iatrogenic acute kidney injury. Contrast-induced nephropathy (CIN) is a main cause of acute renal failure, occurring within 72 hours after the use of iodinated radiographic contrast material (CM).…”

“…Contrast-induced nephropathy (CIN) is a main cause of acute renal failure, occurring within 72 hours after the use of iodinated radiographic contrast material (CM). 21 In fact, the use of CM during imaging is the third most common trigger for iatrogenic acute kidney injury. 22 The pathophysiology of CIN is not fully understood, but it may be caused by direct tubular toxicity and renal ischemic injury.…”

Acute kidney injury and stroke: unresolved issues

“…Second, patients with reduced renal function (baseline eGFR \60 ml/min/ 1.73 m 2 ) were thrice as frequent among AKI developers compared to the rest of the cohort. Pre-existing CKD is a frequent finding among stroke patients [10], and this very fact is reasonable, given the high cardiovascular disease burden intrinsic to CKD per se. CKD stage 2 or higher is a well known major risk factor for cardiovascular diseases including stroke [11], and bears a worse post-stroke prognosis [12]; however, the causes of CKD are not fully ascertained based on the data presented by Wang et al [9].…”

“…Patients with stroke are likely to be more prone to some specific forms of AKI, for example the one caused by mannitol toxicity [13]. Moreover, the potential toxicity of iodinated contrast media used for diagnostic, interventional and monitoring purposes, with the ensuing problem of radiocontrast-induced nephropathy, is to be underscored, although this issue is still highly debated [10,[14][15][16].…”

Risk of Acute Kidney Injury with Consecutive, Multidose Use of Iodinated Contrast in Patients with Acute Ischemic Stroke

“…1,2 Analyses from a number of observational studies suggest that the risk of contrast-induced acute kidney injury (AKI) secondary to CTA/CTP imaging is relatively low in patients with AIS, particularly those with no history of renal impairment. [1][2][3] Apart from CTA/CTP, most patients with AIS, within the time window of recanalization, undergo intra-arterial thrombectomy, which is associated with exposure to additional iodinated contrast medium during DSA. [4][5][6][7][8] Because the potential risk from iodinated contrast exposure is proportional to the dose of contrast medium administered, multiple, consecutive doses of contrast medium could imply a greater risk for AKI.…”