Prevalence of Contrast-Induced Acute Kidney Injury in Acute Ischemic Stroke Patients Undergoing Contrast-Enhanced CT Angiography at a Tertiary Care Centre

Abstract

BACKGROUND
 Multimodal Computed Tomography (CT) imaging with contrast-enhanced CT angiography (CTA) is frequently being used to guide the management of acute ischemic stroke. The administration of contrast media (CM) may lead to nephrotoxicity. However, little has been reported about the safety of intravenous CM exposure in acute stroke patients. This study aims to evaluate whether there is a significant change in renal function following contrast agent administration, determine the proportion of patients developing contrast-induced acute kidney injury(CI-AKI), and analyze the risk factors associated with the same.
 METHODS
 We analysed 138 patients with acute ischemic stroke who underwent emergency CTA at our centre, followed up on the renal parameters and prospectively evaluated them for the development of CI-AKI. The patients who developed CI-AKI were analysed for specific risk factors and categorized into risk groups based on a pre-validated risk score. Univariate and multivariate logistic regression was done to identify independent predictors of CI-AKI.
 RESULTS
 CI-AKI occurred in 19 patients (13.7%). Significant (p<0.001) changes in renal parameters were observed following contrast administration irrespective of whether it satisfied the criteria for CI-AKI. Most of the patients had a low-risk score for CI-AKI. The predicted risk of CI-AKI based on the Mehran Risk Score (MRS) was similar to that observed in our study population. No patient had to be on haemodialysis. Raised baseline S.creatinine(p-value<0.03), Diabetes with microangiopathy(p-value<0.001), and systemic hypertension(p-value<0.001) were significant predictors for CI-AKI.
 CONCLUSIONS
 The development of renal sequelae is low in acute ischemic stroke patients undergoing contrast imaging. Prompt CTA, if indicated, need not be delayed in those with no history of renal impairment or without relevant risk factors. A practical reflection of this study is to be cognizant of the renal risks that an in-patient stroke population is exposed to as Intravascular depletion, infections(urinary tract infections, pneumonia), and nephrotoxic medications.