Abstract 132: Acute Kidney Injury in Acute Ischemic Stroke Patients: Pooled Analysis of ALIAS I and II and IMS III Trials

Background: Acute ischemic stroke patients are at risk of acute kidney injury (AKI) due to volume depletion, contrast exposure and pre-existing co-morbid diseases. We determined the incidence and identified predictors associated with AKI in acute ischemic stroke patients. Methods: Data from the Albumin in Acute Ischemic Stroke trial (ALIAS) - I and II and Interventional Management of Stroke (IMS) - III clinical trials were pooled and analyzed in which acute ischemic stroke patients were randomized into either IV albumin, placebo, endovascular or IV thrombolytic treatment groups. Serum creatinine levels from baseline and within day 5 or discharge along with the demographic and comorbidity information was collected. AKI classification was used to ascertain severity of renal dysfunction and based on increase in serum creatinine levels from baseline, stage 1 ≥ 0.3 mg/dl (≥ 26.4umol/L) or (>1.5 to 2-fold), stage 2 (>2 to 3-fold) and stage 3 (>3-fold) were identified. We analyzed the relationship between AKI and mortality at 3 months post randomization. Results: A total of 1931 acute ischemic stroke patients (mean age 66± 13 (SD) years; 1024 were men) were analyzed. Any increase in serum creatinine was seen in 691 (35.8%, 95% CI 30%-40%) and AKI was seen in 68 (3.5%, 95% CI 3%-4%) of 1931 patients. Severity of AKI was grade I, II, III in 2.1 %, 0.4%, and 0.1% patients, respectively. The risk of AKI was not higher between those who either underwent CT angiography (2% compared with 4.2%, RR 0.5, 95% CI 0.3-0.8, p=0.02) or endovascular treatment (1.9% compared with 4.1%, RR 0.4, 95% CI 0.2-0.8, p=0.0096). Patients with preexisting hypertension (4.3% compared to 1.5%, RR 2.8, 95% CI 1.3-5.7, p=0.006) and preexisting renal disease (9.1% compared to 3.0%, RR 3.1, 95% CI 1.8-5.3, p=0.006) had higher risk of AKI. Mortality at 3 months was significantly higher among patients with AKI (27% compared with 15%, RR 1.8, 95% CI 1.2-2.7, p=0.0083). Conclusions: The incidence of AKI in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of AKI increased mortality at 3 months among acute ischemic stroke patients.

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Abstract 203: Acute Kidney Injury in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: Analysis of the Interventional Management of Stroke (IMS) - III

Stroke ◽

10.1161/str.47.suppl_1.203 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nabeel A Herial ◽

Muhammad A Saleem ◽

Muhammad Shah Miran ◽

Adnan I Qureshi

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Ischemic Stroke ◽

Serum Creatinine ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Stroke Patients ◽

Intravenous Treatment ◽

Stage 1

Background: Endovascular treatment involves cerebral angiography with injection of contrast agents that are nephrotoxic and carry risk of renal failure. Our objective was to determine the incidence and identify predictors associated with acute kidney injury in ischemic stroke patients undergoing endovascular treatment. Materials and methods: Data from the Interventional Management of Stroke (IMS) - III clinical trial was utilized in which acute ischemic stroke patients were randomized into endovascular or intravenous treatment groups. Baseline and day 5 or discharge serum creatinine levels along with the demographic and comorbidity information was collected. Acute Kidney Injury classification was used to ascertain severity of renal dysfunction and based on increase in Day 5 creatinine levels from baseline, stage 1 (1.5 to 2 fold), stage 2 (>2 to 3 fold), and stage 3 renal failure (>3 fold increase from baseline) were identified. Results: Total of 434 patients received ET and 222 patients received intravenous treatment (IVT) with tissue plasminogen activator (tPA). Increase in serum creatinine levels was observed in 52 patients (12%) receiving ET and 24 patients (11%) in the IVT group. Renal failure (stage 1 or higher) was observed in 5 patients (1.2%) in the ET group and 3 patients (1.4%) in the IVT group. In univariate analysis, only age was associated with higher incidence of renal failure in the ET group. No significant association was observed with comorbid diagnoses, particularly pre-existing hypertension or diabetes mellitus. Baseline creatinine level was associated with renal failure (p=0.029) in patients receiving ET and pre-existing diagnosis of renal disorders was associated with renal failure in patients receiving IVT. Conclusions: In the IMS III data, incidence of acute kidney injury in acute ischemic stroke was low and was not different from patients receiving IVT.

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Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke

Journal of Clinical Medicine ◽

10.3390/jcm9051471 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1471

Author(s):

Joonsang Yoo ◽

Jeong-Ho Hong ◽

Seong-Joon Lee ◽

Yong-Won Kim ◽

Ji Man Hong ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Functional Outcomes ◽

Kidney Injury ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Factors Associated

Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic stroke who underwent EVT at three stroke centers in Korea. We compared the characteristics of patients with and without AKI and independent factors associated with AKI after EVT. We also investigated the effects of AKI on functional outcomes and mortality at 3 months. Of the 601 patients analyzed, 59 patients (9.8%) developed AKI and five patients (0.8%) started renal replacement therapy after EVT. In the multivariate analysis, diabetes mellitus (odds ratio (OR), 2.341; 95% CI, 1.283–4.269; p = 0.005), the contrast agent dose (OR, 1.107 per 10 mL; 95% CI, 1.032–1.187; p = 0.004), and unsuccessful reperfusion (OR, 1.909; 95% CI, 1.019–3.520; p = 0.040) were independently associated with AKI. The presence of AKI was associated with a poor functional outcome (OR, 5.145; 95% CI, 2.177–13.850; p < 0.001) and mortality (OR, 8.164; 95% CI, 4.046–16.709; p < 0.001) at 3 months. AKI may also affect the outcomes of ischemic stroke patients undergoing EVT. When implementing EVT, practitioners should be aware of these risk factors.

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Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽

10.1161/str.48.suppl_1.tp13 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ameer E Hassan ◽

Jeffrey L Saver ◽

Mayank Goyal ◽

David S Liebeskind ◽

Reza Jahan ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Pooled Analysis ◽

Favorable Outcome ◽

Stroke Patients ◽

Nihss Score ◽

Post Procedure ◽

Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

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Acute Kidney Injury in Acute Ischemic Stroke Patients in Clinical Trials

Critical Care Medicine ◽

10.1097/ccm.0000000000004464 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Adnan I. Qureshi ◽

Hunain Aslam ◽

Werdah Zafar ◽

Wei Huang ◽

Iryna Lobanova ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clinical Trials ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Stroke Patients

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Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012118 ◽

2016 ◽

Vol 8 (12) ◽

pp. 1231-1234 ◽

Cited By ~ 5

Author(s):

Shelby L Hall ◽

Stephan A Munich ◽

Marshall C Cress ◽

Leonardo Rangel-Castilla ◽

Elad I Levy ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Acute Ischemic Stroke ◽

Creatinine Level ◽

Kidney Injury ◽

Vascular Pathology ◽

Baseline Serum ◽

Iodinated Contrast

BackgroundCombining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.ObjectiveWe aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.MethodsWe identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.ResultsFour patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).ConclusionsThis study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.

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Higher diastolic blood pressure at admission and antiedema therapy is associated with acute kidney injury in acute ischemic stroke patients

International Journal of Nephrology and Renovascular Disease ◽

10.2147/ijnrd.s59443 ◽

2014 ◽

pp. 101 ◽

Cited By ~ 3

Author(s):

Hasan Micozkadioglu

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Diastolic Blood Pressure ◽

Kidney Injury ◽

Stroke Patients

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The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis

PLoS ONE ◽

10.1371/journal.pone.0185589 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0185589 ◽

Cited By ~ 9

Author(s):

Florica Gadalean ◽

Mihaela Simu ◽

Florina Parv ◽

Ruxandra Vorovenci ◽

Raluca Tudor ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

The Impact

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Incidence and Risk Factors of Postcontrast Acute Kidney Injury in Patients with Acute Ischemic Stroke

Stroke Research and Treatment ◽

10.1155/2020/7182826 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Sirichai Chusiri ◽

Aurauma Chutinet ◽

Nijasri Charnnarong Suwanwela ◽

Chankit Puttilerpong

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Kidney Injury ◽

Stroke Patients ◽

Two Factors ◽

Real Practice ◽

Multimodal Ct

Background. Multimodal computed tomography (CT) guides decision-making regarding use of thrombolytic agents in acute ischemic stroke patients. However, postcontrast acute kidney injury (PC-AKI) is a potential adverse effect of the contrast media used, which may require hemodialysis and cause a longer hospital stay. The incidence and risk factors of PC-AKI in acute ischemic stroke patients, particularly in Thailand, remain unclear. Goal. We aimed at determining the incidence and risk factors of PC-AKI in patients with acute ischemic stroke undergoing multimodal CT. Methods. We conducted a retrospective review of Thai acute ischemic stroke patients admitted to the King Chulalongkorn Memorial Hospital between January 2014 and December 2017 who received multimodal CT and thrombolytic treatment with alteplase. Result. Overall, 109 patients were included for analysis; eight patients (7.3%) developed PC-AKI. Estimated glomerular filtration rate eGFR≤30 mL/min and mechanical thrombectomy were risk factors significantly associated with PC-AKI. Conclusion. The incidence of PC-AKI in a real practice setting did not differ from previous reports. Two factors were associated with PC-AKI, eGFR≤30 mL/min and mechanical thrombectomy. Patients without these risk factors may not need to wait for the results of renal function testing prior to multimodal CT.

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Abstract TP181: Albuminuria Should Be A Strong Predictor Of Acute Kidney Injury in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tp181 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Takashi Shimoyama ◽

Satoshi Suda ◽

Yohei Takayama ◽

Takahiro Ouchi ◽

Masafumi Arakawa ◽

...

Keyword(s):

Ischemic Stroke ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Acute Ischemic Stroke ◽

Creatinine Level ◽

Strong Predictor ◽

Kidney Injury ◽

Albumin Level ◽

Stroke Patients ◽

Urine Albumin

Background: Acute kidney injury (AKI) in the setting of cardiovascular events is recognized as a high risk of poor clinical outcome. Although estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes, solid evidence has not yet to be presented regarding the relationship among the two markers and AKI. The present study aimed to clarify this issue in patients with acute ischemic stroke. Methods: From a prospectively gathered registry, we examined acute ischemic stroke patients who were hospitalized within 48 hours after symptom from September 2014 to June 2016. Admission serum creatinine level was considered to be the baseline. AKI is defined by an increase in the serum creatinine level of ≥0.3 mg/dl within 48 hours; or percentage increase of 50% or more from the baseline value within 7 days after admission. We divided all patients into the AKI group and the non-AKI group, and compared clinical characteristics between the two groups. The factors associated with AKI were investigated by multivariate logistic regression analysis. Results: Three hundred and eighty-nine patients (245 males, 74 [65-82] years old) were enrolled in the study. AKI occurred in 14 patients (3.6%) with acute ischemic stroke patients. Compared with patients without AKI, patients with AKI had increased serum creatinine level (1.20 mg/dl vs. 0.80 mg/dl, p=0.033) and urine albumin level (259.6 mg/g vs. 38.7mg/g, P<0.001). On the other hand, eGFR level was decreased in the AKI group than in the non-AKI group (45.5 ml/min/1.73 m 2 vs. 65.0 ml/min/1.73 m 2 , P=0.048). Poor clinical outcome at discharge (mRS ≥5) was frequently observed in the AKI group than the non-AKI group (42.9% vs. 16.5%, P=0.022). The optimal cut-off urine albumin value to distinguish the AKI from the non-AKI using receiver operating characteristics (ROC) curves was 170 mg/g, with 78.6% sensitivity and 79.2% specificity. Multivariate regression analysis showed that urine albumin level > 170mg/g was an independent factor of AKI (odds ratio [OR] 12.73; 95% confidence interval [CI], 3.10-52.30, P<0.001), but not eGFR <60 ml/min/1.73 m 2 (OR 0.96; 95% CI 0.26-3.54, P=0.944). Conclusion: Albuminuria should be a strong predictor for AKI in acute ischemic stroke patients.

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