The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department

sezer eryıldız, ezgi; Karakılıç, Muhammed Evvah; aykaç, özlem; ozakin, engin; Ozdemir, Atilla Ozcan

doi:10.5505/tbdhd.2023.75437

The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department

Özlem AYKAÇ, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskisehir, Türkiye)

Engin ÖZAKIN, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, Eskisehir, Türkiye)

Atilla Özcan ÖZDEMİR, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskisehir, Türkiye)

Muhammed Evvah KARAKILIÇ, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, Eskisehir, Türkiye)

Ezgi Sezer ERYILDIZ (Manisa Şehir Hastanesi, Yoğun Bakım Ünitesi, Manisa, Türkiye)

Türk Beyin Damar Hastalıkları Dergisi

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Yıl: 2023 Cilt: 29 Sayı: 2 Sayfa Aralığı: 68 - 76 Metin Dili: İngilizce DOI: 10.5505/tbdhd.2023.75437 İndeks Tarihi: 27-08-2023

The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department

Öz:

INTRODUCTION: The study investigated the incidence of contrast-induced nephropathy in patients with acute ischemic stroke who received recombinant tissue plasminogen activator (rt-PA) and/or endovascular therapy (EVT) after contrast-enhanced computed tomography (CT) angiography and identified potential risk factors for nephropathy. METHODS: A comparison was made between the groups who received and did not receive contrast material and who developed nephropathy and those who did not, regardless of the use of contrast. Binary logistic regression analysis was used to determine the risk factors for nephropathy. RESULTS: Of 421 patients, 291 (70.9%) were treated with IV rt-PA, and 119 (29%) received EVT. The number of patients receiving contrast media was 194 (75 in CTA and 119 in EVT). No relationship was found between the use of contrast media and the development of nephropathy (p=0.068) and no difference was found in terms of nephropathy between the treatment options (IV rt-PA/endovascular) (p=0.959). Mortality was higher (41.2% versus 15.7%; p<0.001) and mRS at 3rd months was worse (67.6 vs 46.5%; 25 p=0.018) in the group that developed nephropathy (41.2% versus 15.7%; p<0.001). The major risk factors for developing nephropathy in stroke patients were female gender, hemoglobin elevation, and high NIHS score at admission. DISCUSSION AND CONCLUSION: There is utility in obtaining baseline creatinine levels to identify patients at risk of contrast-associated acute kidney injury and to establish a diagnosis of contrast-associated acute kidney in patients with subsequent creatinine rises. However, contrast-requiring diagnostic imaging should not be delayed by waiting for the results of the baseline renal function.

Anahtar Kelime:

Acil servise başvuran akut inme hastalarında vasküler görüntüleme ve endovasküler tedavi sırasında kullanılan kontrast maddenin nefropati ve prognoz üzerindeki etkisi

Öz:

GİRİŞ ve AMAÇ: Çalışma, akut iskemik inme hastalarında kontrastlı bilgisayarlı tomografi (BT) anjiyografisinden sonra rekombinant doku plazminojen aktivatörü (rt-PA) ve/veya endovasküler tedavi (EVT) uygulanan kontrast kaynaklı nefropati insidansını araştırmış ve nefropatiye yol açan potansiyel risk faktörlerini tanımlamıştır. YÖNTEM ve GEREÇLER: Kontrast madde alan ve almayan, nefropati gelişen ve gelişmeyen gruplar arasında kontrast kullanımına bakılmaksızın karşılaştırma yapıldı. Nefropati risk faktörlerini belirlemek için ikili lojistik regresyon analizi kullanıldı. BULGULAR: 421 hastanın 291'i (%70,9) IV rt-PA ile tedavi edildi ve 119'u (%29) EVT aldı. Kontrast madde verilen hasta sayısı 194 (BTA'da 75, EVT'de 119) idi. Kontrast madde kullanımı ile nefropati gelişimi arasında ilişki bulunmadı (p=0,068) ve tedavi seçenekleri arasında (IV rt-PA/endovasküler) nefropati açısından fark bulunmadı (p=0,959). Nefropati gelişen grupta mortalite daha yüksek (%41.2'ye karşı %15.7; p<0.001) ve 3. ayda mRS daha kötüydü (%67.6'ya karşı %46.5; 25 p=0.018) (%41.2'ye karşı %15.7; p<0.001). İnme hastalarında nefropati gelişimi için başlıca risk faktörleri kadın cinsiyet, hemoglobin yüksekliği ve başvuru anında yüksek NIHS skoru idi. TARTIŞMA ve SONUÇ: Kontrastla ilişkili akut böbrek hasarı riski taşıyan hastaları belirlemek ve daha sonra kreatinin yükselmeleri olan hastalarda kontrastla ilişkili akut böbrek tanısı koymak için temel kreatinin düzeylerinin elde edilmesinde fayda vardır. Bununla birlikte, kontrast gerektiren tanısal görüntüleme, başlangıçtaki böbrek fonksiyonunun sonuçları beklenerek geciktirilmemelidir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2019; 50(12): e344-e418.
2. Mohammed NM, Mahfouz A, Achkar K, et al. Contrast-induced nephropathy. Heart views: The official journal of the Gulf Heart Association 2013; 14(3): 106.
3. Chaudhury P, Armanyous S, Harb SC, et al. Intra-arterial versus intravenous contrast and renal injury in chronic kidney disease: A propensity-matched analysis. Nephron 2019; 141(1): 31-40.
4. Moos SI, van Vemde DN, Stoker J, et al. Contrast induced nephropathy in patients undergoing intravenous (iv) contrast enhanced computed tomography (cect) and the relationship with risk factors: A meta-analysis. European journal of radiology 2013; 82(9): e387-e399.
5. Rowe AS, Hawkins B, Hamilton LA, et al. Contrast-induced nephropathy in ischemic stroke patients undergoing computed tomography angiography: Cinister study. Journal of Stroke and Cerebrovascular Diseases 2019; 28(3): 649-654.
6. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. Journal of the American College of Cardiology 2004; 44(7): 1393-1399.
7. Aycock RD, Westafer LM, Boxen JL, et al. Acute kidney injury after computed tomography: A meta-analysis. Annals of emergency medicine 2018; 71(1): 44-53. e44.
8. Lyden P, Brott T, Tilley B, et al. Improved reliability of the nih stroke scale using video training. Ninds tpa stroke study group. Stroke 1994; 25(11): 2220-2226.
9. Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin c. New England Journal of Medicine 2012; 367(1): 20-29.
10. Haveman JW, Gansevoort RT, Bongaerts AH, et al. Low incidence of nephropathy in surgical icu patients receiving intravenous contrast: A retrospective analysis. Intensive care medicine 2006; 32(8): 1199-1205.
11. Rao QA, Newhouse JH. Risk of nephropathy after intravenous administration of contrast material: A critical literature analysis. Radiology 2006; 239(2): 392-397.
12. Krol AL, Dzialowski I, Roy J, et al. Incidence of radiocontrast nephropathy in patients undergoing acute stroke computed tomography angiography. Stroke 2007; 38(8): 2364-2366.
13. Sabeti S, Schillinger M, Mlekusch W, et al. Reduction in renal function after renal arteriography and after renal artery angioplasty. European journal of vascular and endovascular surgery 2002; 24(2): 156-160.
14. Goldenberg I, Matetzky S. Nephropathy induced by contrast media: Pathogenesis, risk factors and preventive strategies. Cmaj 2005; 172(11): 1461-1471.
15. Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. Kidney international 1995; 47(1): 254-261.
16. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: Incidence, risk factors, and relationship to mortality. The American journal of medicine 1997; 103(5): 368-375.
17. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. circulation 2002; 105(19): 2259-2264.
18. Nikolsky E, Mehran R, Turcot D, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. The American journal of cardiology 2004; 94(3): 300-305.
19. Gruberg L, Mintz GS, Mehran R, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. Journal of the American College of Cardiology 2000; 36(5): 1542-1548.
20. Katzberg RW, Barrett BJ. Risk of iodinated contrast material–induced nephropathy with intravenous administration. Radiology 2007; 243(3): 622-628.
21. Katzberg RW, Lamba R. Contrast-induced nephropathy after intravenous administration: Fact or fiction? Radiologic Clinics 2009; 47(5): 789-800.
22. McDonald JS, McDonald RJ, Comin J, et al. Frequency of acute kidney injury following intravenous contrast medium administration: A systematic review and meta-analysis. Radiology 2013; 267(1): 119-128.
23. Josephson SA, Dillon WP, Smith WS. Incidence of contrast nephropathy from cerebral ct angiography and ct perfusion imaging. Neurology 2005; 64(10): 1805-1806.
24. Maeder M, Klein M, Fehr T, et al. Contrast nephropathy: Review focusing on prevention. Journal of the American College of Cardiology 2004; 44(9): 1763-1771.
25. McCullough PA, Adam A, Becker CR, et al. Epidemiology and prognostic implications of contrast-induced nephropathy. The American journal of cardiology 2006; 98(6): 5-13.
26. Mehran R, Nikolsky E. Contrast-induced nephropathy: Definition, epidemiology, and patients at risk. Kidney international 2006; 69: S11-S15.
27. Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium–induced nephropathy. Kidney international 2005; 68(1): 14-22.
28. Weisberg LS, Kurnik PB, Kurnik BR. Radiocontrast–induced nephropathy in humans: Role of renal vasoconstriction. Kidney international 1992; 41(5): 1408-1415.
29. Agmon Y, Peleg H, Greenfeld Z, et al. Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat. The Journal of clinical investigation 1994; 94(3): 1069-1075.
30. Heyman SN, Rosenberger C, Rosen S. Regional alterations in renal haemodynamics and oxygenation: A role in contrast medium-induced nephropathy. Nephrology Dialysis Transplantation 2005; 20(suppl_1): i6-i11.
31. Smith WS, Roberts HC, Chuang NA, et al. Safety and feasibility of a ct protocol for acute stroke: Combined ct, ct angiography, and ct perfusion imaging in 53 consecutive patients. American Journal of Neuroradiology 2003; 24(4): 688-690.

APA	aykaç ö, ozakin e, Ozdemir A, Karakılıç M, sezer eryıldız e (2023). The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. , 68 - 76. 10.5505/tbdhd.2023.75437
Chicago	aykaç özlem,ozakin engin,Ozdemir Atilla Ozcan,Karakılıç Muhammed Evvah,sezer eryıldız ezgi The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. (2023): 68 - 76. 10.5505/tbdhd.2023.75437
MLA	aykaç özlem,ozakin engin,Ozdemir Atilla Ozcan,Karakılıç Muhammed Evvah,sezer eryıldız ezgi The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. , 2023, ss.68 - 76. 10.5505/tbdhd.2023.75437
AMA	aykaç ö,ozakin e,Ozdemir A,Karakılıç M,sezer eryıldız e The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. . 2023; 68 - 76. 10.5505/tbdhd.2023.75437
Vancouver	aykaç ö,ozakin e,Ozdemir A,Karakılıç M,sezer eryıldız e The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. . 2023; 68 - 76. 10.5505/tbdhd.2023.75437
IEEE	aykaç ö,ozakin e,Ozdemir A,Karakılıç M,sezer eryıldız e "The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department." , ss.68 - 76, 2023. 10.5505/tbdhd.2023.75437
ISNAD	aykaç, özlem vd. "The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department". (2023), 68-76. https://doi.org/10.5505/tbdhd.2023.75437

APA	aykaç ö, ozakin e, Ozdemir A, Karakılıç M, sezer eryıldız e (2023). The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. Türk Beyin Damar Hastalıkları Dergisi, 29(2), 68 - 76. 10.5505/tbdhd.2023.75437
Chicago	aykaç özlem,ozakin engin,Ozdemir Atilla Ozcan,Karakılıç Muhammed Evvah,sezer eryıldız ezgi The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. Türk Beyin Damar Hastalıkları Dergisi 29, no.2 (2023): 68 - 76. 10.5505/tbdhd.2023.75437
MLA	aykaç özlem,ozakin engin,Ozdemir Atilla Ozcan,Karakılıç Muhammed Evvah,sezer eryıldız ezgi The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. Türk Beyin Damar Hastalıkları Dergisi, vol.29, no.2, 2023, ss.68 - 76. 10.5505/tbdhd.2023.75437
AMA	aykaç ö,ozakin e,Ozdemir A,Karakılıç M,sezer eryıldız e The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. Türk Beyin Damar Hastalıkları Dergisi. 2023; 29(2): 68 - 76. 10.5505/tbdhd.2023.75437
Vancouver	aykaç ö,ozakin e,Ozdemir A,Karakılıç M,sezer eryıldız e The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. Türk Beyin Damar Hastalıkları Dergisi. 2023; 29(2): 68 - 76. 10.5505/tbdhd.2023.75437
IEEE	aykaç ö,ozakin e,Ozdemir A,Karakılıç M,sezer eryıldız e "The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department." Türk Beyin Damar Hastalıkları Dergisi, 29, ss.68 - 76, 2023. 10.5505/tbdhd.2023.75437
ISNAD	aykaç, özlem vd. "The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department". Türk Beyin Damar Hastalıkları Dergisi 29/2 (2023), 68-76. https://doi.org/10.5505/tbdhd.2023.75437