Engineering

Kidney disease

Surgery

Confounding

Acute kidney injury

Urology

Creatinine

Renal replacement therapy

Mechanical engineering

Percutaneous coronary intervention

Stroke (engine)

Myocardial infarction

Internal medicine

Prospective cohort study

Odds ratio

Medicine

Renal function

Logistic regression

Iohexol

Contrast-induced nephropathy

Stroke

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 &lt;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 &gt;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.

Contrast-Associated Acute Kidney Injury in Endovascular Thrombectomy Patients With and Without Baseline Renal Impairment