Contrast-Associated Acute Kidney Injury in Endovascular Thrombectomy Patients With and Without Baseline Renal Impairment. Issue 12 (December 2019)

• Record Type: Journal Article
• Authors: Diprose, William K.; Sutherland, Luke J.; Wang, Michael T.M.; Barber, P. Alan
• Is Part Of: Stroke. Volume 50:Issue 12(2019)
• Publication Date: 2019-12
• Subjects: acute kidney injury -- creatinine -- glomerular filtration rate -- renal replacement therapy -- thrombectomy; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.119.026738
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: In ischemic stroke, baseline renal impairment is present in 20 to 35% of patients and may increase the risk of contrast-associated acute kidney injury (CA-AKI). We aimed to determine whether endovascular thrombectomy (EVT) patients with baseline renal impairment are at increased risk of CA-AKI. Methods—: Consecutive EVT patients were identified from a prospective database. Patients were stratified by estimated glomerular filtration rate. The primary outcome was CA-AKI assessed at 24 to 72 hours following EVT, defined as an increase in serum creatinine of ≥26.5 µmol/L or 1.5× baseline serum creatinine. Secondary outcomes included requirement for renal replacement therapy and 3-month mortality. Results—: Three hundred thirty-three EVT patients (201 men; mean±SD age 63.9±15.8 years) were included. The mean±SD iohexol contrast volume used in diagnostic and EVT imaging was 236±77 mL per patient. CA-AKI occurred in 11 (3.3%) patients; none required renal replacement therapy, but 4 of 11 (36.4%) had died by 3 months. Propensity score–adjusted logistic regression showed that estimated glomerular filtration rate <30 mL/(min·1.73 m 2 ) was a significant predictor of CA-AKI (odds ratio, 19.93; 95% CI, 2.33–170.74; P =0.006). The dose of contrast was not associated with an increased risk of CA-AKI ( P >0.05). Multiple logistic regression adjusted for potential confounders demonstrated that CA-AKI was independently associated with increased mortality (odds ratio, 4.68; 95% CI, 1.05–20.97; P =0.04). Conclusions—: There is utility in obtaining baseline creatinine levels to identify patients at risk of CA-AKI and to establish a diagnosis of CA-AKI in patients with subsequent creatinine rises. However, contrast-requiring diagnostic imaging and EVT should not be delayed by waiting for the results of baseline renal function.