Post-Contrast Acute Kidney Injury after Acute Stroke—Insights from a German Tertiary Care Center

Abstract

Background: Our aim was to investigate the relationship between additional iodinated contrast medium (CM) application for acute stroke imaging and Post-Contrast Acute Kidney Injury (PC-AKI). Methods: We performed a retrospective analysis of consecutive patients with acute stroke who received a CT angiogram (CTA) with or without additional CT perfusion (CTP) at admission between 2017 and 2020. The primary endpoint was the incidence of PC-AKI. Potential causes of renal function impairment were recorded and logistic regression was performed to determine predictors of PC-AKI. Results: Of 3134 cases screened, n = 989 met the predefined inclusion criteria. PC-AKI occurred in 22 (5.4%) patients who received CTA only and 18 (3.1%) patients who received CTA and additional CTP (unadjusted OR, CI; 0.59, 0.29–1.05). In 31/40 (77.5%) patients who suffered PC-AKI, a non-CM-related cause of renal function impairment was identified. Stroke etiology (hemorrhagic vs. ischemic) and indicators of prior kidney disease were independent predictors of PC-AKI. Conclusions: Additional administration of CM for perfusion imaging in acute stroke did not show a relevant influence on the occurrence of PC-AKI. Patients with intracranial hemorrhage and/or prior kidney disease are at particular risk of developing AKI.

Renal disease is not associated with delays in hyperacute stroke management in South Australia

“…2 Recent studies have suggested that the use of additional contrast medium to facilitate imaging such as CT perfusion is not associated with increased rates of acute kidney injury (AKI). 3 These recommendations are reflected in departmental protocols. Figure 1 presents the component of the institutional code stroke protocol pertaining to renal function and performing scans.…”

“…contrast 2 . Recent studies have suggested that the use of additional contrast medium to facilitate imaging such as CT perfusion is not associated with increased rates of acute kidney injury (AKI) 3 . These recommendations are reflected in departmental protocols.…”