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Safety of cerebral angiography and neuroendovascular therapy in patients with chronic kidney disease

  • Interventional Neuroradiology
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Abstract

Purpose

Contrast-induced nephropathy is a common clinical concern in patients undergoing neuroendovascular procedures, especially in those with pre-existent kidney disease. We aimed to define the incidence of contrast-induced nephropathy in these high-risk patients in our practice.

Methods

We analyzed data retrospectively from patients undergoing neuroendovascular procedures at two academic medical centers over a 4-year period. Contrast-induced nephropathy was determined by an absolute increase in serum creatinine of 0.5 mg/dL or a rise from its baseline value by ≥ 25%, at 48–72 h after exposure to contrast agent after excluding other causes of renal impairment. High-risk patients were identified as those with pre-procedural estimated glomerular filtration rate < 60 mL/min irrespective of creatinine level, corresponding to stages 3–5 of chronic kidney disease.

Results

One hundred eighty-five high-risk patients undergoing conventional cerebral angiography and neuroendovascular interventions were identified. Only 1 out of 184 (0.54%) high-risk patients developed contrast-induced nephropathy. That one patient had stage 5 chronic kidney disease and multiple other risk factors.

Conclusion

We have observed a very low rate of renal injury in patients with chronic kidney disease, traditionally considered high risk for neuroendovascular procedures. Multiple factors may be responsible in the risk reduction of contrast-induced nephropathy in this patient population.

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Abbreviations

CIN:

Contrast-induced nephropathy

CCA:

Conventional cerebral angiography

DM:

Diabetes mellitus

CKD:

Chronic kidney disease

CHF:

Congestive heart failure

eGFR:

Estimated glomerular filtration rate

NAC:

N acetyl cysteine

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Authors and Affiliations

  1. Department of Neurology, University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN, USA

    Jae Kim, Shailesh Male, Bharathi D. Jagadeesan, Christopher Streib & Ramachandra P. Tummala

  2. Department of Neurosurgery, University of Minnesota Medical School and Hennepin County Medical Center, MMC 96, 420 Delaware St. SE, Minneapolis, MN, 55455, USA

    Jae Kim, Shailesh Male, Bharathi D. Jagadeesan & Ramachandra P. Tummala

Authors
  1. Jae Kim
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  2. Shailesh Male
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  3. Bharathi D. Jagadeesan
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  4. Christopher Streib
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  5. Ramachandra P. Tummala
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Corresponding author

Correspondence to Ramachandra P. Tummala.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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For this type of retrospective study formal consent is not required.

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Kim, J., Male, S., Jagadeesan, B.D. et al. Safety of cerebral angiography and neuroendovascular therapy in patients with chronic kidney disease. Neuroradiology 60, 529–533 (2018). https://doi.org/10.1007/s00234-018-1996-2

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  • DOI: https://doi.org/10.1007/s00234-018-1996-2

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