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The following is a summary of “Incidence of Acute Kidney Injury After Exposure to Intravenous Contrast in Emergency Department Patients Presenting for Stroke,” published in the March 2025 issue of Journal of Emergency Medicine by Faruqi et al. 

Chronic kidney disease (CKD) has been considered an independent risk factor for post-CT acute kidney injury, though available data remain limited.  

Researchers conducted a retrospective study to compare the incidence of acute kidney injury (AKI) after intravenous contrast exposure in individuals with and without CKD.  

They assessed individuals who visited the Emergency Department and underwent stroke protocol activation, which included an immediate computed tomography (CT) angiogram. Participants were categorized into 3 groups: “normal to mild” (glomerular filtration rate [GFR] > 60 mL/min/1.73 m²), CKD stage III (GFR 30–60 mL/min/1.73 m²), and CKD stage IV (GFR < 30 mL/min/1.73 m²). The primary outcome measured was the occurrence of AKI. Individuals receiving dialysis were excluded from the study.  

The results showed that among 794 individuals, 452 (56.9%) were categorized as “normal to mild” (GFR > 60 mL/min/1.73 m²), 280 (35.3%) as CKD stage III (GFR 30–60 mL/min/1.73 m²), and 62 (7.8%) as CKD stage IV (GFR < 30 mL/min/1.73 m²), AKI occurred in 2.4% of those with normal GFR, 1.4% with CKD III, and 8.1% with CKD IV, with an overall incidence of 2.5%. Compared to the “normal” group, CKD III had an odds ratio (OR) of 0.58 (95% confidence interval [CI] 0.16–1.72), while CKD IV had an OR of 3.52 (95% CI 1.07–10.05). All individuals with CKD IV who developed AKI showed creatinine improvement before discharge, and none required renal replacement therapy.  

Investigators concluded that the risk of post-CT AKI in patients with CKD III was comparable to those with normal renal function and that patients with CKD IV experienced a lower, transient risk than previously believed, without requiring renal replacement therapy. 

Source: jem-journal.com/article/S0736-4679(24)00322-6/abstract