Incidence of Contrast Material–induced Nephropathy after Neuroendovascular Procedures

Prasad, Vikram; Gandhi, Dheeraj; Stokum, Carly; Miller, Timothy L.; Jindal, Gaurav

doi:10.1148/radiol.14131104

Cited by 21 publications

(14 citation statements)

References 15 publications

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“…Recent studies evaluating the propensity of contrast exposure to induce AKI in noncardiovascular settings demonstrated that intravenous contrast is not an independent risk factor for AKI, dialysis, or mortality. [6][7][8] Importantly, because studies linking CM use to AKI in the setting of pPCI lack a control group in which CM was not administered, it is impossible to distinguish CM-dependent AKI from multiple additional risk factors other than exposure to contrast media. 9 Consequently, studies that include ST-segmentelevation myocardial infarction (STEMI) patients who were not exposed to CM are desirable.…”

mentioning

confidence: 99%

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Caspi

Habib

Cohen

et al. 2017

JAHA

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BackgroundAcute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI) is frequently interpreted as contrast‐induced AKI but may result from other insults. We aimed to determine the causal association of contrast material exposure and the incidence of AKI following pPCI using a control group of propensity score–matched patients with ST‐segment–elevation myocardial infarction who were not exposed to contrast material.Methods and ResultsWe studied 2025 patients with ST‐segment–elevation myocardial infarction who underwent pPCI and 1025 patients receiving fibrinolysis or no reperfusion who were not exposed to contrast material during the first 72 hours of hospital stay (control group). AKI was defined as creatinine of ≥0.5 mg/dL or >25% rise within 72 hours. AKI rates were similar in the pPCI and control groups (10.3% versus 12.1%, respectively; P=0.38). Propensity score matching resulted in 931 matched pairs with PCI and no PCI, with balanced baseline covariates (standardized difference <0.1). Among propensity score–matched patients, AKI rates were not significantly different with and without PCI (8.6% versus 10.9%, P=0.12). In the pPCI cohort, independent predictors of AKI included age ≥70 years, insulin‐treated diabetes mellitus, diuretic therapy, anterior infarction, baseline estimated glomerular filtration rate, and variables related to the presence of pump failure (higher Killip class, intra‐aortic balloon pump use) and reduced left ventricular ejection fraction but not contrast material dose. A risk score based on the PCI cohort had similar discriminatory capacity for AKI in the control group (C statistic 0.81±0.02 and 0.78±0.02, respectively; P=0.26).ConclusionsThe development of AKI in patients with ST‐segment–elevation myocardial infarction undergoing pPCI is mainly related to older age, baseline estimated glomerular filtration rate, heart failure, and hemodynamic instability. Risk for AKI is similar among ST‐segment–elevation myocardial infarction patients with and without contrast material exposure.

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confidence: 99%

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Caspi

Habib

Cohen

et al. 2017

JAHA

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“…They found that only age >75 years was associated with the development of CI-AKI 22. Prasad et al 23 found that the proportion of patients with diabetes was higher among those who developed CI-AKI in patients undergoing a neuroendovascular procedure. Another study showed that among patients with acute ischemic stroke, patients with CI-AKI had a higher baseline serum creatinine level 21.…”

Section: Discussionmentioning

confidence: 99%

Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

Tao

Dong

et al. 2016

J NeuroIntervent Surg

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BackgroundThe correlation between proteinuria and contrast-induced acute kidney injury (CI-AKI) in patients with cerebrovascular disease is still unknown.ObjectiveTo determine whether proteinuria is a risk factor for CI-AKI and death in patients with stroke undergoing cerebral angiography.MethodsData from 2015 patients with stroke undergoing cerebral angiography between January 2009 and December 2013 were retrospectively collected. Clinical parameters were obtained from the hospital's computerized database. All variables were analyzed by univariate analysis and multivariate logistic regression analysis.ResultsCI-AKI was seen in 85 patients (4.2%). After adjustment for potential confounding risk factors, patients with proteinuria had a fivefold higher risk of CI-AKI than patients without proteinuria (OR=5.74; 95% CI 2.23 to 14.83; p<0.001). Other independent risk factors for CI-AKI were estimated glomerular filtration rate <60 mL/min/1.73 m2, anemia, and a high National Institute of Health Stroke Scale score. Proteinuria did not increase in-hospital mortality (OR=1.25; 95% CI 0.49 to 3.17; p=0.639) but did increase 1-year mortality (HR=2.30, 95% CI 1.55 to 3.41, p<0.001).ConclusionsProteinuria is an independent risk factor for CI-AKI and 1-year mortality in patients with stroke undergoing cerebral angiography. More attention should be paid to the development of CI-AKI in patients with stroke with proteinuria.

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“…Altmann et al recommended using the ratio of contrast media volume to creatinine clearance as a predictor for CIN (18). Subsequently, Laskey et al and Prasad et al reported contrast media to creatinine clearance ratios greater than 3.7 and 2.6, respectively, as significant and independent predictors of CIN after percutaneous coronary intervention and neurovascular procedures (19,20). Placed in perspective versus IV contrast media dosing, for a patient with renal insufficiency and a creatinine clearance of 60 mL/min, these thresholds are 222 and 156 mL, respectively.…”

Section: Discussionmentioning

confidence: 99%

Is the Presence of a Solitary Kidney an Independent Risk Factor for Acute Kidney Injury after Contrast-enhanced CT?

McDonald¹,

Katzberg

McDonald³

et al. 2016

Radiology

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Incidence of Contrast Material–induced Nephropathy after Neuroendovascular Procedures

Abstract: Risk of developing CIN CM-induced nephropathy is relatively low in patients who undergo neuroendovascular procedures with CM contrast material doses of 250 mL or greater.

Cited by 21 publications

References 15 publications

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

Is the Presence of a Solitary Kidney an Independent Risk Factor for Acute Kidney Injury after Contrast-enhanced CT?

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