title: Association Between Acute Kidney Disease and Intravenous Dye Administration in Patients With Acute Stroke: A Population-Based Study.
abstract: 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.
authors.affiliation: 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.). Stacie.demel@gmail.com.
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Demel
authors.affiliation: 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.).
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Grossman
authors.affiliation: 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.).
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.affiliation: 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.).
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.affiliation: 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.).
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.affiliation: 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.).
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.affiliation: 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.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.affiliation: 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.).
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.affiliation: 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.).
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.affiliation: 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.).
authors.forename: Jason
authors.initials: J
authors.lastname: Mackey
authors.affiliation: 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.).
authors.forename: Felipe
authors.initials: F
authors.lastname: De Los Rios la Rosa
authors.affiliation: 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.).
authors.forename: Sharyl
authors.initials: S
authors.lastname: Martini
authors.affiliation: 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.).
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: 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.).
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002533:Cerebral Angiography / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D054879:Halogenation; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology
chemical_list: D003287:Contrast Media
keywords: acute kidney injury; contrast media; diagnostic imaging; epidemiology; stroke