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Association Between Acute Kidney Disease and Intravenous Dye Administration in Patients With Acute Stroke: A
Stacie L Demel1, Aaron W Grossman2, Jane C Khoury2
1From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.). Stacie.demel@gmail.com.
Insights
Contrast dye for stroke imaging is generally safe for kidneys. A large study found no link between dye use and acute kidney injury (AKI) in stroke patients, even those with pre-existing kidney disease.
Area of Science:
- Nephrology
- Neurology
- Radiology
Background:
- Computed tomographic angiography and conventional angiography are vital for stroke diagnosis.
- Iodinated contrast dye, used in these procedures, poses a risk of acute kidney injury (AKI).
- Understanding the incidence of AKI in stroke patients receiving contrast dye is crucial.
Purpose of the Study:
- To examine the in-hospital incidence of new or worsening kidney disease in stroke patients.
- To determine the association between intravenous dye administration and kidney disease in stroke patients.
Main Methods:
- A retrospective study included adult stroke patients presenting to emergency departments in 2010.
- Prevalence of unsuspected kidney disease and incidence of AKI were determined.
- Patients were grouped based on intravenous dye administration.
Main Results:
- 37% of 2299 stroke patients had baseline kidney disease, with 22% of these cases being unsuspected.
- The incidence of AKI was low: 2% in patients with baseline kidney disease and 1% in those without.
- No association was found between dye administration and new or worsening kidney disease.
Conclusions:
- The incidence of new or worsening kidney disease in stroke patients is low.
- Contrast dye administration was not associated with an increased risk of AKI.
- These findings support the safety of contrast dye in stroke imaging, even in patients with kidney disease.
Background And Purpose:
Computed tomographic angiography and conventional angiography provide timely vascular anatomic information in patients with stroke. However, iodinated contrast dye may cause acute kidney injury (AKI). Within a large, biracial population, we examined in-hospital incidence of new or worsening kidney disease in patients with stroke and its association with administration of intravenous dye.
Methods:
All adult residents of the Greater Cincinnati/Northern Kentucky region with acute ischemic stroke or intracerebral hemorrhage who presented to an emergency department in 2010 were included. Prevalence of unsuspected kidney disease at the time of emergency department presentation and the incidence of AKI after admission in 2 groups of patients-those who did and those who did not receive intravenous dye-were determined.
Results:
In 2010, 2299 patients met inclusion criteria (89% ischemic stroke and 11% intracerebral hemorrhage); mean age 69 years (SD 15), 22% black, and 54% women. Among these patients, 37% had kidney disease at baseline, including 22% (516/2299) in whom this was unsuspected. Two percent (2%; 15/853) of patients with baseline kidney disease developed AKI during the hospital stay. Of those with no baseline kidney disease, 1% (14/14 467) developed AKI. There was no association between dye administration and new or worsening kidney disease.
Conclusions:
Although 22% of patients in the Greater Cincinnati/Northern Kentucky stroke population had unsuspected kidney disease, the incidence of new or worsening kidney disease was low, and AKI was not associated with dye administration. These findings confirm single-center reports that the risk of severe renal complications after contrast dye is small.
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