Incidence of Acute Kidney Injury After Exposure to Intravenous Contrast in Emergency Department Patients Presenting for Stroke
Authors: Imran Faruqi, Terrell Caffery, Maddie Colter, et al.
Journal: Journal of Emergency Medicine, 2024
Conclusions:
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CKD III patients do not have a significantly increased risk of post-CTA AKI compared to those with normal renal function.
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CKD IV patients have an elevated AKI risk, but the injury was transient and non-progressive, with no cases requiring renal replacement therapy.
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This challenges historical caution around IV contrast use, suggesting CTA may be safer than previously thought, even in advanced CKD.
Methods:
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Design: Retrospective single-center study
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Population: 794 ED patients undergoing stroke protocol CTA
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Groups:
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Normal to Mild Renal Function: GFR > 60 mL/min/1.73 m² (n = 452)
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CKD Stage III: GFR 30–60 mL/min/1.73 m² (n = 280)
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CKD Stage IV: GFR < 30 mL/min/1.73 m² (n = 62)
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Exclusions: Patients on dialysis
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Outcome: Incidence of AKI post-contrast, defined by changes in serum creatinine
Results:
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Overall AKI Incidence: 2.5% (n ≈ 20)
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By Group:
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Normal to Mild GFR: 2.4% AKI incidence
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CKD III: 1.4% AKI incidence
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CKD IV: 8.1% AKI incidence
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Odds Ratios for AKI (compared to normal renal function):
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CKD III vs. Normal: OR = 0.58 (95% CI: 0.16–1.72)
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CKD IV vs. Normal: OR = 3.52 (95% CI: 1.07–10.05)
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Key Findings:
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AKI in CKD IV was transient—all patients improved before discharge, none required dialysis.
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No significant difference in AKI risk between normal renal function and CKD III.
Faruqi, I., Caffery, T., Colter, M., Williams, C., Trent, A., Cushner, D., Nelson, J. and Davis, G., 2024. Incidence of Acute Kidney Injury After Exposure to Intravenous Contrast in Emergency Department Patients Presenting for Stroke. The Journal of Emergency Medicine.
Keywords: Contrast-induced nephropathy, acute kidney injury, CTA, stroke protocol, chronic kidney disease, emergency medicine.