Contrast-induced acute kidney injury in acute ischaemic stroke patients

Abstract

Purpose The potential nephrotoxicity of intravenous iodinated contrast media is a major concern for acute ischaemic stroke imaging evaluation. This study aimed to assess the incidence of acute kidney injury after intravenous iodinated contrast media exposure in acute ischaemic stroke patients. Methods We conducted a retrospective cohort analysis between January 2012 and July 2018 to select adult patients admitted to the emergency department with acute ischaemic stroke. The exposed patients received a uniform intravenous dose of low osmolar non-ionic iodinated contrast media, as part of the imaging protocol for acute ischaemic stroke. The unexposed patients underwent a non-enhanced cranial computed tomography scan. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcomes criteria, limited to the first 72 hours. Results A total of 161 and 105 patients were included in the exposed and unexposed groups, respectively. The median age was 72.8 years (interquartile range 20), 53% were men and 97% were white. Demographic and baseline characteristics were similar between the groups. The incidence of acute kidney injury between exposed ( n = 10, 6.2%) and unexposed ( n = 1, 1%) groups ( P = 0.073) was similar and contrast exposure was not a significant predictor of acute kidney injury. Conclusion Intravenous iodinated contrast media exposure during acute ischaemic stroke imaging protocols is not an independent predictor of acute kidney injury in patients with normal or near-normal renal function. Studies with larger sample sizes would help to clarify if patients with both cardiovascular risk factors and impaired renal function could benefit from prophylactic measures.

The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review

“…Overall, the definition used impacted the CIN incidence reported, but reasons for choosing a particular definition were not mentioned in most studies (n = 12). Only six studies justified their definition by stating that it was a common criterion used in various literatures [ 13 , 20 , 21 , 26 , 27 , 28 ]. Hence, the definitions will be further discussed in terms of the sCr measurements and the post-CECT sCr collection time used.…”

“…An absolute sCr increase of ≥0.3 mg/dL or ≥1.5-fold increase over baseline sCr was also used to define CIN in three different studies and they reported varying incidence of 6.2% [ 21 ], 7.2% [ 23 ], and 13.2% [ 20 ]. Hence, besides factors such as sample size, CT scan region, and patient characteristics, the sCr value and range utilized in the definition of CIN is critical and could have contributed to the wide variation in CIN incidence.…”

“…The incidence of adverse renal events is generally low in the ED. Three studies revealed that dialysis was not required in ED patients with CIN [ 31 , 33 , 34 ], whereas low incidences of dialysis were demonstrated in six studies [ 12 , 13 , 20 , 21 , 27 , 28 ]. Of these, studies performed by Huang et al [ 28 ], Brito et al [ 21 ], and Dağar et al [ 12 ] found low incidences of temporary haemodialysis, with no patients requiring permanent haemodialysis.…”

“…Three studies revealed that dialysis was not required in ED patients with CIN [ 31 , 33 , 34 ], whereas low incidences of dialysis were demonstrated in six studies [ 12 , 13 , 20 , 21 , 27 , 28 ]. Of these, studies performed by Huang et al [ 28 ], Brito et al [ 21 ], and Dağar et al [ 12 ] found low incidences of temporary haemodialysis, with no patients requiring permanent haemodialysis. Hsu et al [ 25 ] also had no patients who required chronic dialysis, despite a relatively high incidence of emergent dialysis performed.…”

“…Three studies demonstrated the association between CHF and CIN development [ 23 , 27 , 29 ], with only Brito et al [ 21 ] reporting otherwise. Acute hypotension can also predispose patients to CIN [ 12 , 18 , 28 ].…”