OBJECTIVES: Although intravenous contrast in neuroimaging has become increasingly important in selecting patients for stroke treatment, clinical concerns remain regarding contrast-associated acute kidney injury (CA-AKI). Given the increasing utilization of CT angiography and/or perfusion coupled with cerebral angiography, the purpose of this study was to assess the association of CA-AKI and multi-dose iodinated contrast in acute ischemic stroke (AIS) patients.

METHODS: Retrospective review of AIS patients at a comprehensive stroke center was performed from January 2018 to December 2019. Data collection included patient demographics, stroke risk factors, stroke severity, discharge disposition, modified Rankin Scale, contrast type/volume, and creatinine levels (baseline, 48-72 hours). CA-AKI was defined as creatinine increase more than 25% from baseline. Bivariate analyses and multivariable logistic regression models were implemented to compare AIS patients with multi-dose and single-dose contrast.

RESULTS: Of 440 AIS patients, 215 (48.9%) were exposed to a single-dose contrast, and 225 (51.1%) received multi-dose. In single-dose patients, CA-AKI at 48/72 hours was 9.7%/10.2% compared to 8.0%/8.9% in multi-dose patients. Multi-dose patients were significantly more likely to receive a higher volume of contrast (mean 142.1mL versus 80.8mL; p<0.001), but there was no significant difference in their creatinine levels or CA-AKI. NIHSS score (OR=1.08, 95% CI=[1.04,1.13]), and patient transfer from another hospital (OR=3.84, 95% CI=[1.94,7.62]) were significantly associated with multi-dose contrast.

CONCLUSIONS: No significant association between multi-dose iodinated contrast and CA-AKI was seen in AIS patients. Concerns of CA-AKI should not deter physicians from pursuing timely and appropriate contrast-enhanced neuroimaging that may optimize treatment outcomes in AIS patients.