Waleed Brinjikji1, Andrew M Demchuk2, Mohammad H Murad2, Alejandro A Rabinstein2, Robert J McDonald2, Jennifer S McDonald2, David F Kallmes2. 1. From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.). Brinjikji.waleed@mayo.edu. 2. From the Department of Radiology (W.B., R.J.M., J.S.M., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Division of Preventive Medicine and Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN; and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Alberta, Canada (A.M.D.).
Abstract
BACKGROUND AND PURPOSE: Because of the perceived risk of contrast-induced acute kidney injury (AKI), many centers require pre-imaging serum creatinine levels, potentially delaying care. We performed a systematic review and meta-analysis evaluating AKI rates in patients with acute ischemic stroke receiving computed tomographic angiography (CTA) and computed tomographic perfusion (CTP). METHODS: We searched MEDLINE, EMBASE, and the Web of Science through December 2016 for studies reporting on AKI in patients with acute ischemic stroke receiving CTA/CTP. Using a random-effects model, estimates were pooled across studies. Outcomes of interest were (1) the odds of AKI in patients receiving CTA/CTP versus noncontrast computed tomography, (2) overall rate of AKI and hemodialysis in patients with acute ischemic stroke undergoing CTA/CTP, and (3) the odds of CTA/CTP-associated AKI among patients with and without chronic kidney disease. RESULTS: Fourteen studies were included (6 case-control studies and 8 single-arm studies) with 5727 CTA/CTP and 981 noncontrast computed tomography patients. In case-control studies, AKI was significantly lower among CTA/CTP patients compared with noncontrast computed tomography patients (odds ratio=0.47; 95% confidence interval=0.33-0.68; P<0.01). Adjusting for baseline creatinine, there was no difference in AKI rates between groups (odds ratio=0.34; 95% confidence interval=0.10-1.21). The overall rate of AKI in CTA/CTP patients was 3% (95% confidence interval=2%-4%). The overall rate of hemodialysis in the CTA/CTP group was 0.07% (3 of 4373). There was no difference in AKI among CTA/CTP patients with and without chronic kidney disease (odds ratio=0.63; 95% confidence interval=0.34-1.12). CONCLUSIONS: Nonrandomized evidence suggests that CTA/CTP are not associated with statistically significant increase in risk of AKI in patients with stroke, even those with known chronic kidney disease.
BACKGROUND AND PURPOSE: Because of the perceived risk of contrast-induced acute kidney injury (AKI), many centers require pre-imaging serum creatinine levels, potentially delaying care. We performed a systematic review and meta-analysis evaluating AKI rates in patients with acute ischemic stroke receiving computed tomographic angiography (CTA) and computed tomographic perfusion (CTP). METHODS: We searched MEDLINE, EMBASE, and the Web of Science through December 2016 for studies reporting on AKI in patients with acute ischemic stroke receiving CTA/CTP. Using a random-effects model, estimates were pooled across studies. Outcomes of interest were (1) the odds of AKI in patients receiving CTA/CTP versus noncontrast computed tomography, (2) overall rate of AKI and hemodialysis in patients with acute ischemic stroke undergoing CTA/CTP, and (3) the odds of CTA/CTP-associated AKI among patients with and without chronic kidney disease. RESULTS: Fourteen studies were included (6 case-control studies and 8 single-arm studies) with 5727 CTA/CTP and 981 noncontrast computed tomography patients. In case-control studies, AKI was significantly lower among CTA/CTPpatients compared with noncontrast computed tomography patients (odds ratio=0.47; 95% confidence interval=0.33-0.68; P<0.01). Adjusting for baseline creatinine, there was no difference in AKI rates between groups (odds ratio=0.34; 95% confidence interval=0.10-1.21). The overall rate of AKI in CTA/CTPpatients was 3% (95% confidence interval=2%-4%). The overall rate of hemodialysis in the CTA/CTP group was 0.07% (3 of 4373). There was no difference in AKI among CTA/CTPpatients with and without chronic kidney disease (odds ratio=0.63; 95% confidence interval=0.34-1.12). CONCLUSIONS: Nonrandomized evidence suggests that CTA/CTP are not associated with statistically significant increase in risk of AKI in patients with stroke, even those with known chronic kidney disease.
Authors: J Latus; V Schwenger; G Schlieper; H Reinecke; J Hoyer; P B Persson; B A Remppis; F Mahfoud Journal: Internist (Berl) Date: 2020-12-21 Impact factor: 0.743