Abstract
Background: CT angiography (CTA) and conventional angiogram provide timely vascular anatomical information in stroke patients. However, the iodinated contrast dye may cause renal injury. Within a large, biracial population, we examined in-hospital incidence of new or worsening RI in stroke patients and its association with administration of intravenous (IV) dye. Methods: All residents of the Greater Cincinnati/Northern Kentucky region ≥ 20 years of age with ischemic stroke (IS), subarachnoidhemorrhage (SAH), or intracerebral hemorrhage (ICH) who presented to an emergency department in 2010 and survived at least two days were included. Medical records from the acute hospitalization were retrospectively reviewed, and age, race, sex, stroke risk factors, admission serum creatinine (Cr), vascular imaging, and metformin use were abstracted. Incidence of RI was assessed and stratified by use of IV dye. RI on presentation was defined as history of RI or ESRD or Cr ≥ 1.5 on admission. Development of RI during the hospital stay was defined as renal failure/insufficiency after day 2 of hospitalization or new dialysis documented in the record. Results: In 2010, 2350 stroke patients in the region met inclusion criteria (86% IS, 11% ICH, 3% SAH); mean age 69 years (SD 15), 22% black, 54% female. Among these patients, 22% had RI at baseline, 25 (3%) developed new RI, while 11 (2% had worsening RI during hospitalization). Among all 2350 patients, 340 (14%) had IV dye-based vascular imaging. Table presents demographics and incidence of new or worsening RI stratified by IV dye administration. Discussion: Incidence of new or worsening renal insufficiency in stroke patients in this population based study was extremely low (36/2350; 1.5%). One patient had severe enough RI to warrant new dialysis. We did not find an association between IV dye and new or worsening RI. This confirms prior single-center reports that the risk of severe renal complications after contrast dye is extremely low.
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