Incidence of Acute Kidney Injury After Computed Tomography Angiography±Computed Tomography Perfusion Followed by Thrombectomy in Patients With Stroke Using a Postprocedural Hydration Protocol

Abstract Background and Aims Contrast-induced acute kidney injury nephropathy (CI-AKI) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. Advanced age has been reported as risk factor for CI-AKI. However, limited studies available to determine the exact incidence of CI-AKI in elderly patient. The aim of this study was to investigate the incidence of, risk factors for developing CI-AKI in patient above 65 years old who underwent Pulmonary Computed Tomography Angiography (PCTA). Method This single center retrospective study, performed in a large, tertiary care hospital in Riyadh, Saudi Arabia. It is a sub-study of (3 P-CIAKI) The Practice Pattern of Preventive Measures for Contrast Induced Acute Kidney Injury in Patients Undergoing Pulmonary Computed Tomography Angiography. Patients > 65 years of age, who underwent PCTA during a 5-year period (2014 to 2018) were included. Patients receiving long-term hemodialysis or peritoneal dialysis, and those without repeated serum creatinine 48-72 hours post procedure were excluded from the analysis. CI-AKI defined as raise of serum creatinine by 44 mmol/l 48-72 hours post PCTA. Results 272 out of 908 patients, with a mean age of 74.93 ± 7.09 years, 58.1% having diabetes mellitus (DM) and estimated GFR of 74.92 ± 23.57 ml/min per 1.73 m2 were enrolled. 201 patients (73.9%) had eGFR > 60 ml/min. Diuretics was used by 37.1% of the patients, while 33.1 % of the patients on ACEI / ARBs. Prophylactic measures used in 35.7 % of the procedures. CI-AKI occurred in 19 cases (7.0 %) as compared with 4.7 % in the original 3 P-CIAKI study with mean age of 52 years and eGFR 97 ml/min. Renal replacement therapy required in 3 patients who had CI-AKI. DM status was only significant predictor for the development of CI-AKI. Conclusion Elderly patients are at greater risk for the development of CI-AKI even with eGFR above 60 ml/min specially in DM patient .The Incidence of CI-AKI in patients > 65 years of age is up to 7 %, that is less than the reported in the literature and this can be explained by higher base line eGFR in our study .

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Does Preoperative Computed Tomography Angiography Lead to an Increased Incidence of Postoperative Acute Kidney Injury Following Transcatheter Aortic Valve Implantation in Patients with Impaired Renal Function?

ARC Journal of Surgery ◽

10.20431/2455-572x.0504001 ◽

2019 ◽

Vol 5 (4) ◽

Keyword(s):

Computed Tomography ◽

Acute Kidney Injury ◽

Renal Function ◽

Aortic Valve ◽

Computed Tomography Angiography ◽

Impaired Renal Function ◽

Kidney Injury ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2019.02.015 ◽

2019 ◽

Vol 12 (12) ◽

pp. 2460-2471 ◽

Cited By ~ 18

Author(s):

Gianluca Pontone ◽

Andrea Baggiano ◽

Daniele Andreini ◽

Andrea I. Guaricci ◽

Marco Guglielmo ◽

...

Keyword(s):

Computed Tomography ◽

Fractional Flow Reserve ◽

Computed Tomography Angiography ◽

Dynamic Stress ◽

Coronary Computed Tomography Angiography ◽

Fractional Flow ◽

Computed Tomography Perfusion ◽

Coronary Computed Tomography ◽

Flow Reserve ◽

Whole Heart

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Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.351 ◽

2016 ◽

Vol 43 (3) ◽

pp. 375-380 ◽

Cited By ~ 2

Author(s):

Cheemun Lum ◽

Matthew J. Hogan ◽

John Sinclair ◽

Shane English ◽

Howard Lesiuk ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Transit Time ◽

Cerebral Artery ◽

Computed Tomography Angiography ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Mean Transit Time ◽

Arterial Diameter ◽

Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

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Risk of acute kidney injury after contrast-enhanced computed tomography in emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920913397 ◽

2020 ◽

pp. 102490792091339

Author(s):

Seda Dağar ◽

Emine Emektar ◽

Hüseyin Uzunosmanoğlu ◽

Şeref Kerem Çorbacıoğlu ◽

Özge Öztekin ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Acute Kidney Injury ◽

Intensive Care ◽

Contrast Media ◽

Kidney Injury ◽

Intravenous Contrast ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

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