Contrast-Associated Acute Kidney Injury After Endovascular Therapy for Acute Ischemic Stroke: A Meta-Analysis

This study aimed to investigate the incidence of contrast-associated acute kidney injury (CA-AKI) and renal replacement therapy (RRT) after endovascular therapy (EVT) for acute ischemic stroke.

PubMed, the Cochrane Library, and the Web of Science were searched to identify all relevant studies regarding the incidence of CA-AKI and RRT in patients with acute ischemic stroke receiving EVT until July 2021. To pool the incidence of CA-AKI and RRT, a random-effects model with a double arcsine transformation was used. Subgroup analysis and meta-regression analysis were used to investigate the relationship of individual study-level covariates with CA-AKI and RRT.

It was found that 15 studies involving 27 246 patients with acute ischemic stroke receiving EVT met the inclusion criteria. The incidence of CA-AKI was 5.0% (95% CI, 2.1%-8.9%), and the incidence of RRT was 0.2% (95% CI, 0.0%-0.4%). Subgroup analysis showed that the incidence of CA-AKI was higher when using the European Society of Urogenital Radiology's criteria (6.6%, 95% CI, 3.8%-10.1%) than when using the Kidney Disease: The Improving Global Outcomes criteria (3.0%, 95% CI, 1.0%-6.1%). Meta-regression analysis confirmed that the presence of diabetes was associated with increased rates of CA-AKI (P=0.002); however, the rates of CA-AKI were not elevated because of impaired baseline estimated glomerular filtration rate (P=0.518), chronic kidney disease (P=0.860), or the volume of contrast (P=0.536).

The risk of CA-AKI and RRT secondary to EVT is low for patients with acute ischemic stroke; therefore, treatment should not be delayed for the patients eligible for EVT by waiting for the results of renal function analysis.