Comparison of postcontrast acute kidney injury based on previous and current diagnostic criteria following cerebral angiography in patients with acute ischemic stroke: a comparative case-control study

Abstract

Background: Physicians often face challenges in deciding whether to perform imaging for patients with acute ischemic stroke(AIS) in the emergency department due to concerns about postcontrast acute kidney injury (PC-AKI) risk. The conventional PC-AKI definition has been criticized for overestimating AKI incidence, leading to the introduction of a revised diagnostic criterion. However, There is limited research on how well this new definition reflects PC-AKI, particularly regarding diagnostic rate changes in acute ischemic stroke patients undergoing cerebral angiography. This study aimed to assess the impact of updated diagnostic criteria on PC-AKI incidence in patients with AIS undergoing cerebral angiography in emergency departments. Methods: We hypothesized that the new criteria would result in lower PC-AKI diagnosis rates compared to the previous criteria. Data of 381 patients aged ≥18 years with AIS who visited the emergency department at a tertiary university hospital in Seoul, South Korea, and who underwent cerebral angiography between October 2018 and June 2023 were retrospectively analyzed. After applying selection criteria, 361 patients were included in the analysis. The primary outcome measure was the PC-AKI incidence based on previous and updated diagnostic criteria. Secondary outcomes included subgroup PC-AKI incidence analyses based on baseline estimated glomerular filtration rate (eGFR) intervals and prognostic outcome comparisons using area under the curve (AUC) values with 95% confidence intervals. Results: The incidence of PC-AKI was significantly lower under the updated criteria compared with the previous criteria (p = 0.048). Using the relative criterion resulted in nearly a three-fold lower PC-AKI incidence (p = 0.002). Patients with baseline eGFRs ≥90 mL/min/1.73 m2 also had a significantly lower PC-AKI incidence under the updated criteria (p = 0.03). Conclusions: This study demonstrates that the updated PC-AKI diagnostic criteria result in a lower reported incidence than the previous criteria, which may influence clinical decision-making in patients with AIS.