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.