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DE Rubeis G, Zilahi DE Gyurgyokai S, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Biondi-Zoccai G, Versaci F, Saba L, Pampana E. Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression. Minerva Med 2024; 115:151-161. [PMID: 38563606 DOI: 10.23736/s0026-4806.23.09093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI). METHODS A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates. RESULTS A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03). CONCLUSIONS Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.
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Affiliation(s)
- Gianluca DE Rubeis
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy -
| | | | - Sebastiano Fabiano
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca R Pezzella
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Sabrina Anticoli
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Versaci
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Monserrato, Cagliari, Italy
| | - Enrico Pampana
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
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Wrona P, Sawczyńska K, Wróbel D, Zdrojewska K, Giełczyński M, Mizera P, Brzegowy P, Popiela T, Słowik A, Krzanowski M. Risk factors of acute kidney injury during hospitalization in acute ischaemic stroke patients undergoing mechanical thrombectomy. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:89-94. [PMID: 38616933 PMCID: PMC11008514 DOI: 10.5114/aic.2024.136374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Acute kidney injury (AKI) seems to worsen the prognosis of acute ischaemic stroke (AIS) patients treated with mechanical thrombectomy (MT). At the same time, the procedure of MT increases AKI risk by iodinated contrast use. Identification of factors predisposing to AKI after MT is important for recognizing vulnerable patients and successful prevention. Aim To identify factors associated with the occurrence of AKI during hospitalization in MT-treated AIS patients. Material and methods The study included all AIS patients treated with MT in the University Hospital in Krakow from 2019 to 2021. The diagnosis of AKI during hospitalisation was based on serum creatinine concentration levels, according to the Kidney Disease Improving Global Outcomes guidelines. We compared patients with and without AKI in terms of age, sex, comorbidities, stroke course and laboratory test results at admission. We identified factors associated with the occurrence of AKI using univariate logistic regression analysis, with significant variables subsequently added to the multivariate analyses. Results Among 593 MT-treated AIS patients the incidence of AKI during hospitalisation was 12.6%. AKI development was associated with diabetes, chronic kidney disease, total volume of iodinated contrast obtained during hospitalisation, posterior circulation stroke, lack of intravenous thrombolysis, and laboratory test results at admission: haemoglobin, glucose, urea, potassium, and creatinine. Total contrast volume and urea level were the most important independent risk factors associated with occurrence of AKI. Conclusions AKI is common in MT-treated AIS patients. There is a need to establish a protocol for decreasing the risk of AKI in AIS patients undergoing MT and, in case it occurs, a procedure for its treatment.
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Affiliation(s)
- Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Wróbel
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Kaja Zdrojewska
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Giełczyński
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Mizera
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Krzanowski
- Department of Nephrology and Dialysis, Jagiellonian University Medical College, Krakow, Poland
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Oliveira M, Rocha A, Barbosa F, Barros P, Fonseca L, Ribeiro M, Afreixo V, Gregório T. Acute kidney injury after endovascular therapy in acute stroke patients: systematic review with meta-analysis. J Neurointerv Surg 2023; 15:e468-e474. [PMID: 36797049 DOI: 10.1136/jnis-2022-019955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
AIMS Endovascular therapy (EVT) is a highly effective stroke treatment, but it requires the administration of contrast media which puts patients at risk of acute kidney injury (AKI). AKI is associated with increased morbidity and mortality in cardiovascular patients. METHODS PubMed, Scopus, ISI and the Cochrane Library were systematically searched for observational and experimental studies assessing the occurrence of AKI in adult acute stroke patients submitted to EVT. Two independent reviewers collected study data regarding study setting, period, source of data, and AKI definition and predictors, the outcomes of interest being AKI incidence and 90-day death or dependency (modified Rankin Scale score ≥3). These outcomes were pooled using random effect models, and heterogeneity was measured using the I2 statistic. RESULTS 22 studies were identified and included in the analysis, involving 32 034 patients. Pooled incidence of AKI was 7% (95% CI 5% to 10%), but heterogeneity was high across studies (I2=98%), and not accounted for by the definition of AKI used. The most frequently reported AKI predictors were impaired baseline renal function (5 studies) and diabetes (3 studies); 3 studies (2103 patients) reported data on death and 4 studies (2424 patients) reported data on dependency. Overall, AKI was associated with both outcomes, with ORs of 6.21 (95% CI 3.52 to 10.96) and 2.86 (95% CI 1.88 to 4.37), respectively. Heterogeneity was low for both analyses (I2=0%). CONCLUSIONS AKI affects 7% of acute stroke patients submitted to EVT and identifies a subgroup of patients for which treatment outcomes are suboptimal, with an increased risk of death and dependency.
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Affiliation(s)
- Marta Oliveira
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Ana Rocha
- Department of Medical Sciences, Universidade de Aveiro, Aveiro, Portugal
| | - Flávia Barbosa
- Department of Medical Sciences, Universidade de Aveiro, Aveiro, Portugal
| | - Pedro Barros
- Stroke Unit, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
- Neurology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Luísa Fonseca
- Stroke Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Ribeiro
- Cerebrovascular Interventional Neuroradiology Unit, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications, University of Aveiro, Aveiro, Portugal
| | - Tiago Gregório
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
- Stroke Unit, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
- MEDCIDS, Universidade do Porto Faculdade de Medicina, Porto, Portugal
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Laible M, Jenetzky E, Möhlenbruch MA, Bendszus M, Ringleb PA, Rizos T. The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Front Neurol 2021; 12:665614. [PMID: 34163423 PMCID: PMC8215575 DOI: 10.3389/fneur.2021.665614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT. Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models. Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001). Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.
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Affiliation(s)
- Mona Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neurology, University of Ulm, Ulm, Germany
| | - Ekkehart Jenetzky
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.,Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany
| | | | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Timolaos Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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5
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Lee JS, Hwang YH, Sohn SI. Factors Contributing to an Efficacious Endovascular Treatment for Acute Ischemic Stroke in Asian Population. Neurointervention 2021; 16:91-110. [PMID: 33765729 PMCID: PMC8261106 DOI: 10.5469/neuroint.2020.00339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Although randomized control trials about endovascular treatment (EVT) of emergent large vessel occlusion (LVO) have demonstrated the success of mechanical thrombectomy as the choice of treatment, a wide range of caveats remain unaddressed. Asian patients were rarely included in the trials, thereby raising the question of whether the treatment could be generalized. In addition, there remains a concern on the feasibility of the method with respect to its application against intracranial atherosclerosis (ICAS)-related LVO, frequently observed in the Asian population. It is important to include evidence on ICAS LVO from Asian countries in the future for a comprehensive understanding of LVO etiology. Besides the issues with EVT, prognostic concerns in diabetes patients, acute kidney injury following EVT, neuroprotective management against reperfusion injury, and other peri-EVT issues should be considered in clinical practice. In the current article, we present an in-depth review of the literature that revises information pertaining to such concerns.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Kyemyung University School of Medicine, Daegu, Korea
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Nozaki T, Noda M, Ishibashi T, Otani K, Kogiku M, Abe K, Kishi H, Morita A. Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy. AJNR Am J Neuroradiol 2021; 42:306-312. [PMID: 33361373 DOI: 10.3174/ajnr.a6906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Obtaining information on invisible vasculature distal to the occlusion site helps to deploy a stent retriever safely during mechanical thrombectomy for large-vessel occlusion. It is essential to reduce the amount of contrast used for detecting the vessels distal to the occlusion site because acute ischemic stroke patients tend to have chronic kidney disease and patients with severe chronic kidney disease are at an increased risk of contrast-associated acute kidney injury. We assessed whether vessels distal to the occlusion site during acute ischemic stroke with large-vessel occlusion could be visualized on angiographic images using flat panel detector CT acquired following intra-arterial diluted contrast injection, compared with MRA findings. MATERIALS AND METHODS Between May 2019 and January 2020, we enrolled 28 consecutive patients with large-vessel occlusions of the anterior circulation eligible for mechanical thrombectomy following MR imaging. The patients underwent CBV imaging using flat panel detector CT with an intra-arterial diluted contrast injection instead of intravenous injection. Flat panel detector CT angiographic images reconstructed from the same dataset were evaluated for image quality, collateral status of the MCA territory, and visualization of the vessels distal to the occlusion site. These findings were compared with MRA findings. RESULTS Twenty-two patients were retrospectively examined. Flat panel detector CT angiographic image quality in 20 patients (91%) was excellent or good. The distal portion of the occluded vessel segment was visualized in 14 patients (70%), while the proximal portion of the segment adjacent to the occluded vessel in 3 (15%) was visualized. No visualization was observed in only 1 patient (5%) with no collateral supply. Flat panel detector CT angiographic images were shown to evaluate vessels distal to the occlusion site more accurately than MRA. CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, flat panel detector CT angiographic images could successfully visualize vessels distal to the occlusion site with a small amount of contrast material.
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Affiliation(s)
- T Nozaki
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
- Department of Neurological Surgery (T.N., A.M.), Nippon Medical School Hospital, Tokyo, Japan
| | - M Noda
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - T Ishibashi
- Department of Neurosurgery (T.I.), Jikei University School of Medicine, Tokyo, Japan
| | - K Otani
- Siemens Healthcare K.K. (K.O.), Tokyo, Japan
| | - M Kogiku
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - K Abe
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - H Kishi
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - A Morita
- Department of Neurological Surgery (T.N., A.M.), Nippon Medical School Hospital, Tokyo, Japan
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7
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Cereda CW, Mlynash M, Cippà PE, Kemp S, Heit JJ, Marks MP, Lansberg MG, Albers GW. Renal Safety of Multimodal Brain Imaging Followed by Endovascular Therapy. Stroke 2020; 52:313-316. [PMID: 33250038 DOI: 10.1161/strokeaha.120.030816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced noninvasive angiography and perfusion imaging are recommended to identify eligible patients for endovascular therapy (EVT) in extended time windows (>6 hours or wake-up). If eligible, additional intraarterial contrast exposure will occur during EVT. We aimed to study the renal safety in the DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) population, selected with contrast-enhanced multimodal Imaging and randomized to EVT versus medical management. METHODS In the randomized DEFUSE 3 trial population, we compared changes in serum creatinine between baseline (before randomization) and 24 hours later. The primary outcome was the relative change in creatinine level between baseline and 24 hours in the EVT versus medical arm. The secondary outcome was a comparison between computed tomography (CT) versus magnetic resonance imaging selection in the EVT arm. The safety outcome was a comparison of the proportion of patients with criteria for contrast-associated kidney injury in the EVT versus medical arm and a comparison between CT versus magnetic resonance imaging selection in the EVT arm. RESULTS In the DEFUSE 3 population (n=182, age 69±13, 51% female), mean creatinine decreased from a baseline of 0.98±0.33 mg/dL to 0.88±0.28 mg/dL at 24 hours (P<0.001). There was no difference in change between treatment groups: relative to baseline, there was a 6.3% reduction in the EVT group versus 9.2% in the medical group, P=0.294. Absolute decrease -0.08±0.18 in EVT versus -0.12±0.18 in medical, P=0.135; Among patients treated with EVT, there was no difference in 24-hour creatinine level changes between patients who were selected with CT angiography/CT perfusion (-0.08±0.18) versus magnetic resonance imaging (-0.07±0.19), P=0.808 or 6.8% reduction versus 4.8%, P=0.696. In the EVT arm, contrast-associated kidney injury was encountered in 4 out of 91 (4.4%) versus 2/90 (2.2%) in the medical arm P=0.682. In the EVT arm, contrast-associated kidney injury was evenly distributed between magnetic resonance imaging (1/22, 4.6%) versus CT 3 out of 69 (4.4%), P=1.0. CONCLUSIONS Perfusion imaging before EVT was not associated with evidence of decline in renal function. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02586415.
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Affiliation(s)
- Carlo W Cereda
- Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Michael Mlynash
- Stanford Stroke Center (M.M., S.K., M.G.L., G.W.A.), Stanford University School of Medicine, CA
| | - Pietro E Cippà
- Division of Nephrology, EOC, Lugano, Switzerland (P.E.C.)
| | - Stephanie Kemp
- Stanford Stroke Center (M.M., S.K., M.G.L., G.W.A.), Stanford University School of Medicine, CA
| | - Jeremy J Heit
- Department of Radiology (J.J.H., M.P.M.), Stanford University School of Medicine, CA
| | - Michael P Marks
- Department of Radiology (J.J.H., M.P.M.), Stanford University School of Medicine, CA
| | - Maarten G Lansberg
- Stanford Stroke Center (M.M., S.K., M.G.L., G.W.A.), Stanford University School of Medicine, CA
| | - Gregory W Albers
- Stanford Stroke Center (M.M., S.K., M.G.L., G.W.A.), Stanford University School of Medicine, CA
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Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke. J Clin Med 2020; 9:jcm9051471. [PMID: 32422921 PMCID: PMC7291207 DOI: 10.3390/jcm9051471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic stroke who underwent EVT at three stroke centers in Korea. We compared the characteristics of patients with and without AKI and independent factors associated with AKI after EVT. We also investigated the effects of AKI on functional outcomes and mortality at 3 months. Of the 601 patients analyzed, 59 patients (9.8%) developed AKI and five patients (0.8%) started renal replacement therapy after EVT. In the multivariate analysis, diabetes mellitus (odds ratio (OR), 2.341; 95% CI, 1.283–4.269; p = 0.005), the contrast agent dose (OR, 1.107 per 10 mL; 95% CI, 1.032–1.187; p = 0.004), and unsuccessful reperfusion (OR, 1.909; 95% CI, 1.019–3.520; p = 0.040) were independently associated with AKI. The presence of AKI was associated with a poor functional outcome (OR, 5.145; 95% CI, 2.177–13.850; p < 0.001) and mortality (OR, 8.164; 95% CI, 4.046–16.709; p < 0.001) at 3 months. AKI may also affect the outcomes of ischemic stroke patients undergoing EVT. When implementing EVT, practitioners should be aware of these risk factors.
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Li X, Partovi S. Save the Brain First: CTA and Mechanical Thrombectomy in Patients at Risk for Contrast-Induced Nephropathy. AJNR Am J Neuroradiol 2020; 41:637-638. [PMID: 32217552 DOI: 10.3174/ajnr.a6515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/07/2022]
Affiliation(s)
- X Li
- Section of Interventional Radiology, Imaging InstituteCleveland Clinic FoundationCleveland, Ohio
| | - S Partovi
- Section of Interventional Radiology, Imaging InstituteCleveland Clinic FoundationCleveland, Ohio
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10
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Weber R, van Hal R, Stracke P, Hadisurya J, Nordmeyer H, Chapot R. Incidence of Acute Kidney Injury After Computed Tomography Angiography±Computed Tomography Perfusion Followed by Thrombectomy in Patients With Stroke Using a Postprocedural Hydration Protocol. J Am Heart Assoc 2020; 9:e014418. [PMID: 32067579 PMCID: PMC7070223 DOI: 10.1161/jaha.119.014418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The risk of contrast-induced acute kidney injury (AKI) in patients with stroke receiving both computed tomography (CT) angiography and mechanical thrombectomy has been investigated only in small case series. No studies have investigated whether additional CT perfusion or chronic kidney disease (CKD) are associated with higher rates of AKI. Methods and Results Retrospective analysis of the AKI incidence in 1089 consecutive patients receiving CT angiography and mechanical thrombectomy from 2015 to 2017 and in subgroups with CKD (n=99) and CT perfusion (n=104) was performed. Patients received a standardized hydration protocol. Data on kidney function after mechanical thrombectomy were available in 1017 patients. A total of 59 (5.8%) patients developed AKI, and only 4 (6.8%) patients needed hemodialysis, all with known CKD. Patients with AKI significantly more often had known CKD (20.3% versus 8.4%, P=0.002), diabetes mellitus (33.9% versus 20.9%, P=0.018), and tandem occlusion (32.2% versus 16.2%, P=0.003) and a significantly higher in-hospital mortality (20.3% versus 7.0%, P<0.001) compared with patients without AKI. However, there were no significant independent predictors for AKI in multivariable logistic regression analysis. Sex (odds ratio [OR], 2.03; 95% CI, 1.17-3.52 [P=0.012]), higher National Institutes of Health Stroke Scale (OR, 1.10; 95% CI, 1.05-1.14 [P<0.001]), AKI (OR, 3.52; 95% CI, 1.63-7.64 [P=0.001]), diuretic use (OR, 1.80; 95% CI, 1.02-3.19), futile or incomplete recanalization (OR, 0.19; 95% CI, 0.09-0.40 [P<0.001]), and total volume of contrast agent volume (OR, 1.007; 95% CI, 1.002-1.011 [P=0.004]) were independently associated with in-hospital death. Two thirds of the patients with AKI died of severe brain damage and not AKI itself. Conclusions Post-contrast AKI rarely occurs in patients with stroke receiving a contrast agent for CT angiography/CT perfusion and subsequent mechanical thrombectomy. Patients with known CKD had higher rates of AKI and only these patients needed hemodialysis, but CKD was not independently associated with AKI or in-hospital mortality.
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Affiliation(s)
- Ralph Weber
- Department of Neurology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine Ruhr-University Bochum Germany
| | - Robert van Hal
- Department of Neurology Alfried Krupp Krankenhaus Essen Germany
| | - Paul Stracke
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine University Hamburg Germany
| | | | - Hannes Nordmeyer
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine University Witten-Herdecke Germany
| | - René Chapot
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany
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Diprose WK, Sutherland LJ, Wang MT, Barber PA. Contrast-Associated Acute Kidney Injury in Endovascular Thrombectomy Patients With and Without Baseline Renal Impairment. Stroke 2019; 50:3527-3531. [DOI: 10.1161/strokeaha.119.026738] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- William K. Diprose
- From the Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand (W.K.D., M.T.M.W., P.A.B.)
- Department of Neurology (W.K.D., P.A.B.), Auckland City Hospital, New Zealand
| | - Luke J. Sutherland
- Department of Renal Medicine (L.J.S.), Auckland City Hospital, New Zealand
| | - Michael T.M. Wang
- From the Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand (W.K.D., M.T.M.W., P.A.B.)
| | - P. Alan Barber
- From the Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand (W.K.D., M.T.M.W., P.A.B.)
- Department of Neurology (W.K.D., P.A.B.), Auckland City Hospital, New Zealand
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12
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Jia ZY, Wang SX, Zhao LB, Cao YZ, Shi HB, Liu S. Risk of Acute Kidney Injury with Consecutive, Multidose Use of Iodinated Contrast in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2019; 40:652-654. [PMID: 30679214 DOI: 10.3174/ajnr.a5959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/18/2018] [Indexed: 11/07/2022]
Abstract
Currently, CTA is the imaging technique most frequently used to evaluate acute ischemic stroke, and patients with intracranial large-vessel occlusion usually undergo endovascular treatment. This single-center, prospective, cohort study showed that consecutive, multidose use of contrast during CTA and DSA does not increase the incidence of acute kidney injury in patients with acute ischemic stroke, though acute kidney injury tended to have a higher incidence in the contrast multiexposure group (P = .172).
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Affiliation(s)
- Z Y Jia
- From the Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - S X Wang
- From the Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - L B Zhao
- From the Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Y Z Cao
- From the Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - H B Shi
- From the Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - S Liu
- From the Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
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13
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Joo C, Park E, Min JW, Kang H, Yoo DS, Jung HJ. Contrast Media-Induced Nephropathy in Patients with Unruptured Cerebral Aneurysm After Coiling Endovascular Treatment. World Neurosurg 2018; 121:e39-e44. [PMID: 30196168 DOI: 10.1016/j.wneu.2018.08.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have been limited. Thus, we evaluated the incidence and risk factors for CIN in patients who had undergone cerebral aneurysmal coiling procedures. METHODS We retrospectively reviewed the electric medical records of 380 patients who had undergone cerebral aneurysmal coiling treatment under general anesthesia. CIN was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or a relative increase (≥25%) in the baseline serum creatinine value at 48-72 hours after exposure to a contrast agent. RESULTS Elective cerebral aneurysmal coiling procedures were performed in 230 patients. Of the 230 patients, CIN developed in 13 (5.6%). The presence of diabetes mellitus (30.8% vs. 9.7%; P = 0.040) and patient age >75 years (30.8% vs. 6.5%; P = 0.012) were risk factors for CIN. CONCLUSIONS Our study has demonstrated that the incidence of CIN in patients undergoing elective cerebral aneurysmal coiling procedures is ∼6.0%. We also identified underlying diabetes mellitus and advanced age (≥75 years) as potential risk factors.
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Affiliation(s)
- Chunghee Joo
- Department of Anesthesia and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunhye Park
- Department of Anesthesia and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Won Min
- Department of Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang-si, Republic of Korea
| | - Hyun Kang
- Department of Department of Anesthesia and Pain Medicine, Chung-Ang University, College of Medicine, Seoul, Republic of Korea
| | - Do-Sung Yoo
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Ju Jung
- Department of Anesthesia and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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14
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Brinjikji W, Demchuk AM, Murad MH, Rabinstein AA, McDonald RJ, McDonald JS, Kallmes DF. Neurons Over Nephrons: Systematic Review and Meta-Analysis of Contrast-Induced Nephropathy in Patients With Acute Stroke. Stroke 2017; 48:1862-1868. [PMID: 28583996 DOI: 10.1161/strokeaha.117.016771] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/24/2017] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Because of the perceived risk of contrast-induced acute kidney injury (AKI), many centers require pre-imaging serum creatinine levels, potentially delaying care. We performed a systematic review and meta-analysis evaluating AKI rates in patients with acute ischemic stroke receiving computed tomographic angiography (CTA) and computed tomographic perfusion (CTP). METHODS We searched MEDLINE, EMBASE, and the Web of Science through December 2016 for studies reporting on AKI in patients with acute ischemic stroke receiving CTA/CTP. Using a random-effects model, estimates were pooled across studies. Outcomes of interest were (1) the odds of AKI in patients receiving CTA/CTP versus noncontrast computed tomography, (2) overall rate of AKI and hemodialysis in patients with acute ischemic stroke undergoing CTA/CTP, and (3) the odds of CTA/CTP-associated AKI among patients with and without chronic kidney disease. RESULTS Fourteen studies were included (6 case-control studies and 8 single-arm studies) with 5727 CTA/CTP and 981 noncontrast computed tomography patients. In case-control studies, AKI was significantly lower among CTA/CTP patients compared with noncontrast computed tomography patients (odds ratio=0.47; 95% confidence interval=0.33-0.68; P<0.01). Adjusting for baseline creatinine, there was no difference in AKI rates between groups (odds ratio=0.34; 95% confidence interval=0.10-1.21). The overall rate of AKI in CTA/CTP patients was 3% (95% confidence interval=2%-4%). The overall rate of hemodialysis in the CTA/CTP group was 0.07% (3 of 4373). There was no difference in AKI among CTA/CTP patients with and without chronic kidney disease (odds ratio=0.63; 95% confidence interval=0.34-1.12). CONCLUSIONS Nonrandomized evidence suggests that CTA/CTP are not associated with statistically significant increase in risk of AKI in patients with stroke, even those with known chronic kidney disease.
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Affiliation(s)
- Waleed Brinjikji
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.).
| | - Andrew M Demchuk
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.)
| | - Mohammad H Murad
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.)
| | - Alejandro A Rabinstein
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.)
| | - Robert J McDonald
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.)
| | - Jennifer S McDonald
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.)
| | - David F Kallmes
- From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.)
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15
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Tao Y, Dong W, Li Z, Chen Y, Liang H, Li R, Mo L, Xu L, Liu S, Shi W, Zhang L, Liang X. Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography. J Neurointerv Surg 2017; 9:445-448. [PMID: 27106594 PMCID: PMC5520258 DOI: 10.1136/neurintsurg-2016-012349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/31/2016] [Accepted: 04/02/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The correlation between proteinuria and contrast-induced acute kidney injury (CI-AKI) in patients with cerebrovascular disease is still unknown. OBJECTIVE To determine whether proteinuria is a risk factor for CI-AKI and death in patients with stroke undergoing cerebral angiography. METHODS Data from 2015 patients with stroke undergoing cerebral angiography between January 2009 and December 2013 were retrospectively collected. Clinical parameters were obtained from the hospital's computerized database. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. RESULTS CI-AKI was seen in 85 patients (4.2%). After adjustment for potential confounding risk factors, patients with proteinuria had a fivefold higher risk of CI-AKI than patients without proteinuria (OR=5.74; 95% CI 2.23 to 14.83; p<0.001). Other independent risk factors for CI-AKI were estimated glomerular filtration rate <60 mL/min/1.73 m2, anemia, and a high National Institute of Health Stroke Scale score. Proteinuria did not increase in-hospital mortality (OR=1.25; 95% CI 0.49 to 3.17; p=0.639) but did increase 1-year mortality (HR=2.30, 95% CI 1.55 to 3.41, p<0.001). CONCLUSIONS Proteinuria is an independent risk factor for CI-AKI and 1-year mortality in patients with stroke undergoing cerebral angiography. More attention should be paid to the development of CI-AKI in patients with stroke with proteinuria.
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Affiliation(s)
- Yiming Tao
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
| | - Wei Dong
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
| | - Zhilian Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
| | - Yuanhan Chen
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huaban Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruizhao Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liyi Mo
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
| | - Lixia Xu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
| | - Wei Shi
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
| | - Li Zhang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- SouthernMedical University, Guangzhou, China
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16
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Prasad V, Gandhi D, Stokum C, Miller T, Jindal G. Incidence of contrast material-induced nephropathy after neuroendovascular procedures. Radiology 2014; 273:853-8. [PMID: 25102293 DOI: 10.1148/radiol.14131104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report the incidence and risk factors for contrast material ( CM contrast material )-induced nephropathy ( CIN CM-induced nephropathy ) in patients with no history of chronic kidney disease and estimated glomerular filtration rate that exceeded 30 mL/min/1.73 m(2) after a relatively high dose of CM contrast material (≥250 mL) during neuroendovascular procedures. MATERIALS AND METHODS An institutional review board-approved retrospective chart review was performed for all patients who received a dose of CM contrast material 250 mL or greater while they underwent a neuroendovascular procedure between January 2011 and February 2013. The control group consisted of comparable patients who received a CM contrast material dose of 75-249 mL during the same period. Patients with pre-existing estimated glomerular filtration rate of 30 mL/min/1.73 m(2) or less or documented history of chronic kidney disease were excluded. CIN CM-induced nephropathy was defined as an increase in serum creatinine 50% above the baseline or an absolute increase of 0.3 mg/dL at either 24 or 48 hours after the procedure. Statistical analysis was performed with the Student t test, χ(2) analysis, and mixed-model analysis of variance. RESULTS Clinical characteristics between the control and high-dose group were similar for age (95% confidence interval [CI]: -3.69, 5.48; P = .70), sex (95% CI: 0.28, 0.43; P = .62), and ethnicity (95% CI: 0.42, 0.58; P = .47). The average volume of CM contrast material administered was 172 mL in the control group and 326 mL in the high-dose cohort (95% CI: 131.78, 175.05; P < .001). Of the 79 cases in the high-dose cohort, 36 (46%) received a CM contrast material dose between 250 and 299 mL, 29 (37%) received 300-399 mL, nine (11%) received 400-499 mL, and five (6%) received greater than 500 mL. By 48 hours, a statistically significant decrease in serum creatinine was seen in two of the four high-dose CM contrast material dose categories: 250-299 mL (decrease of 24%; [95% CI: 0.04, 0.36]; P = .003) and greater than 500 mL (decrease of 14% [95% CI: -0.33, 0.57]; P = .007). There were four cases (5%) of CIN CM-induced nephropathy : three (4%) at 24 hours and one (1%) at 48 hours. The comorbid rate of diabetes (25% vs 15% [95% CI: -0.01, 0.04]; P < .001) was found to be higher among those who developed CIN CM-induced nephropathy compared with those who did not within the high-dose cohort. No cases of CIN CM-induced nephropathy occurred in the control group. CONCLUSION Risk of developing CIN CM-induced nephropathy is relatively low in patients who undergo neuroendovascular procedures with CM contrast material doses of 250 mL or greater.
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Affiliation(s)
- Vikram Prasad
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Interventional Neuroradiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
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17
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The incidence of contrast-induced nephropathy (CIN) following transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC). Eur Radiol 2014; 24:1105-11. [PMID: 24526284 DOI: 10.1007/s00330-014-3099-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/03/2014] [Accepted: 01/15/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this retrospective study was to investigate the incidence of contrast-induced nephropathy (CIN) caused by transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS One hundred forty-one patients treated between 2005 and 2008 undergoing 305 consecutive sessions of TACE were enrolled. CIN was defined as an increase in the serum creatinine level of more than 0.5 mg/dl or more than 25 % from baseline within 3 days after TACE without any other identifiable cause of acute kidney injury. RESULTS CIN by the present definition was observed after 2.6 % of the TACE sessions. No patient showed clinical signs or symptoms of acute renal failure, or required haemodialysis. None of the patients with an estimated glomerular filtration rate of <60 ml/min/1.73 m(2) developed CIN. CONCLUSION The present study suggests that TACE is a relatively safe procedure in terms of the risk of CIN under vigorous periprocedural hydration and that the incidence of CIN is comparable to that of AKI associated with intravenous CM administration. KEY POINTS • CIN would be lower for non-coronary arterial intervention than for coronary intervention. • The present study suggests that the CIN rates following TACE are low. • The incidence of CIN is comparable to that after intravenous CM administration.
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18
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Kato T, Sakai H, Tsujimoto M, Nishimura Y. Prolonged carotid sinus reflex is a risk factor for contrast-induced nephropathy following carotid artery stenting. AJNR Am J Neuroradiol 2011; 32:441-5. [PMID: 21273355 DOI: 10.3174/ajnr.a2344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS. MATERIALS AND METHODS We examined 80 patients who underwent CAS between April 2005 and December 2009. Clinical background, laboratory data, contrast volume, and clinical course were collected and analyzed. RESULTS The incidence of CIN was 8.8% (7/80), and no patients required hemodialysis. In the group that developed CIN, prolonged CSR after CAS was found in 57.1% (4/7) of cases; this incidence differed significantly (P = .001) from that in the group without development of CIN. Neither preoperative renal function, contrast volume, nor history was related to the incidence of CIN, while on multivariate analysis, prolonged CSR was found to be an independent risk factor for CIN. The incidence of elevation in creatinine values at 6 months after CAS was 8.2% (6/73). All patients who developed delayed renal impairment had pre-existing CKD; this finding differed significantly (P = .04) from that in the group without development of delayed renal impairment. CONCLUSIONS Because patients who develop prolonged CSR after CAS are at increased risk of perioperative major adverse clinical events including CIN, patients at high risk for this condition should be carefully managed to prevent increased morbidity and mortality.
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Affiliation(s)
- T Kato
- Department of Neurosurgery, National Hospital Organization, Toyohashi Medical Center, Aichi, Japan.
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