Demel Stacie L, Grossman Aaron W, Khoury Jane C, Moomaw Charles J, Alwell Kathleen, Kissela Brett M, Woo Daniel, Flaherty Matthew L, Ferioli Simona, Mackey Jason, De Los Rios la Rosa Felipe, Martini Sharyl, Adeoye Opeolu, Kleindorfer Dawn O
From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.).
Stroke. 2017 Apr;48(4):835-839. doi: 10.1161/STROKEAHA.116.014603. Epub 2017 Mar 3.
Computed tomographic angiography and conventional angiography provide timely vascular anatomic information in patients with stroke. However, iodinated contrast dye may cause acute kidney injury (AKI). Within a large, biracial population, we examined in-hospital incidence of new or worsening kidney disease in patients with stroke and its association with administration of intravenous dye.
All adult residents of the Greater Cincinnati/Northern Kentucky region with acute ischemic stroke or intracerebral hemorrhage who presented to an emergency department in 2010 were included. Prevalence of unsuspected kidney disease at the time of emergency department presentation and the incidence of AKI after admission in 2 groups of patients-those who did and those who did not receive intravenous dye-were determined.
In 2010, 2299 patients met inclusion criteria (89% ischemic stroke and 11% intracerebral hemorrhage); mean age 69 years (SD 15), 22% black, and 54% women. Among these patients, 37% had kidney disease at baseline, including 22% (516/2299) in whom this was unsuspected. Two percent (2%; 15/853) of patients with baseline kidney disease developed AKI during the hospital stay. Of those with no baseline kidney disease, 1% (14/14 467) developed AKI. There was no association between dye administration and new or worsening kidney disease.
Although 22% of patients in the Greater Cincinnati/Northern Kentucky stroke population had unsuspected kidney disease, the incidence of new or worsening kidney disease was low, and AKI was not associated with dye administration. These findings confirm single-center reports that the risk of severe renal complications after contrast dye is small.
计算机断层血管造影和传统血管造影可为中风患者及时提供血管解剖信息。然而，碘化造影剂可能会导致急性肾损伤（AKI）。在一个大型的双种族人群中，我们研究了中风患者新发或恶化的肾脏疾病的院内发病率及其与静脉注射造影剂的关系。
纳入2010年在大辛辛那提/北肯塔基地区急诊科就诊的所有急性缺血性中风或脑出血的成年居民。确定两组患者（接受和未接受静脉注射造影剂的患者）在急诊科就诊时未被怀疑的肾脏疾病患病率以及入院后急性肾损伤的发生率。
2010年，2299例患者符合纳入标准（89%为缺血性中风，11%为脑出血）；平均年龄69岁（标准差15），22%为黑人，54%为女性。在这些患者中，37%在基线时有肾脏疾病，其中22%（516/2299）未被怀疑。基线时有肾脏疾病的患者中有2%（2%；15/853）在住院期间发生了急性肾损伤。在无基线肾脏疾病的患者中，1%（14/14467）发生了急性肾损伤。造影剂给药与新发或恶化的肾脏疾病之间没有关联。
尽管在大辛辛那提/北肯塔基中风人群中22%的患者有未被怀疑的肾脏疾病，但新发或恶化的肾脏疾病的发生率较低，且急性肾损伤与造影剂给药无关。这些发现证实了单中心报告中关于造影剂后严重肾脏并发症风险较小的观点。
