DOI: 10.54996/anatolianjem.1907608 ISSN: 2651-4311

Does CT Angiography for Suspected Acute Stroke Cause Acute Kidney Injury?

Erhan Altunbaş, Mustafa Altun, Emir Ünal, Çiğdem Özpolat
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Aim: This study aimed to determine the incidence of contrast-associated acute kidney injury (CA-AKI) and identify its associated clinical determinants in patients presenting to the emergency department with suspected acute ischemic stroke who underwent contrast-enhanced cranio-cervical computed tomography angiography (CTA).Material and Methods: This retrospective, single-center cohort study was conducted in the emergency department of a tertiary stroke center between March and September 2024, including consecutive patients who underwent cranio-cervical CTA for suspected stroke. Patients aged ≥18 years with available 7-day follow-up data were included; those requiring dialysis or with incomplete records were excluded. Patients were classified by glomerular filtration rate (GFR) into normal/mild chronic kidney disease (CKD), CKD III, and CKD IV groups. The primary outcome was AKI, defined as a serum creatinine increase of ≥0.3 mg/dL within 48 hours or ≥1.5-fold from baseline within 7 days. Independent predictors were assessed using multivariable logistic regression.Results: A total of 282 patients were analyzed (211 with normal/mild CKD, 61 with CKD III, 10 with CKD IV). AKI developed in 20 patients (7%). Patients who developed AKI differed significantly from those who did not in terms of ICU admission, hemorrhagic stroke diagnosis, use of inotropes, calcium channel blockers, antibiotics, steroids, and anticonvulsants, and the volume of intravenous fluids administered (p<0.05 for all). Age, sex, and eGFR did not differ significantly between groups. On multivariable analysis, ICU admission (OR 4.72), inotrope use (OR 37.82), and IV fluid volume (OR 0.27) were independent predictors of AKI. No significant difference in AKI incidence was observed between patients with normal GFR and those with CKD III/IV (p=0.985).Conclusion: AKI may develop in patients undergoing cranio-cervical CTA for suspected stroke; however, no significant association between impaired GFR and AKI was demonstrated. Careful use of nephrotoxic medications and balanced intravenous fluid replacement may reduce AKI development. Fear of CA-AKI should not delay or preclude diagnostic CTA or endovascular procedures in acute ischemic stroke patients at risk of large vessel occlusion.

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