Authors: Zainab Alhussain , Abdullah Alhwaid , Ahmed Alkhazi , Mohammed Alsheddi , Aminah Alturki , Fahad Alhawas , Hind Alabdulatif , Malak Alsugayer , Sara Habib , Shaden Alharbi

Abstract

Background: Contrast Media (CM) imaging is a critical component of acute stroke management. Nevertheless, the risk of Post-Contrast Acute Kidney Injury (PC-AKI) in patients who undergo computed tomography angiography (CTA) or computed tomography perfusion (CTP) is a topic of controversy.
Aim: This study aimed to estimate the incidence and assess the predictors of PC-AKI after neurological imaging in adult patients with acute stroke.
Methods: This retrospective cohort study was conducted at the National Guard - Health Affairs, Riyadh, Saudi Arabia. Medical records of adult patients diagnosed with acute stroke who underwent CTA/CTP were reviewed. PC-AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥1.5-1.9 times the baseline level 48 hours after CM administration.
Results: The study included 741 consecutive patients. PC-AKI incidence was 1.8% (95% CI: 0.98%, 3.1%). Univariate logistic regression analysis showed that increased risk of PC-AKI was significantly associated with chronic kidney disease (p < 0.001), elevated baseline serum creatinine (p = 0.006), and decreased GFR (p < 0.001). Multivariate logistic regression showed that only decreased GFR <30 ml/minute/1.73 m2 was an independent risk factor for developing PC-AKI.
Conclusion: Patients with acute stroke have a low incidence of PC-AKI. In order to facilitate the subsequent identification of patients who may develop acute kidney injury, baseline creatinine levels should be obtained without postponing the implementation of the appropriate imaging modalities. Close monitoring and protection against PC-AKI are necessary for patients with a baseline estimated glomerular filtration rate of less than 30 ml/minute/1.73 m2, as the known benefits and potential hazards of contrast imaging must be considered.

Keywords: Acute kidney injury, contrast media, diagnostic imaging, intracranial hemorrhage, ischemic stroke.