Contrast-Induced Acute Kidney Injury in Patients Followed at the Intensive Care Unit after Aneurysmal Subarachnoid Haemorrhage (Fisher Grade IV) Surgery:A Retrospective Study

Year 2023, Volume: 5 Issue: 4, 271 - 281, 29.10.2023

Hamide Ayben Korkmaz , Rıfat Akdağ , İlkay Ceylan

https://doi.org/10.46310/tjim.1358676

Abstract

Background: Contrast-enhanced imaging studies are widely used to diagnose and follow up acute cerebrovascular diseases. Exposure to contrast media may lead to nephropathy. This study investigated the incidence of contrast-induced acute kidney injury during intensive care follow-up of patients who underwent aneurysmal subarachnoid haemorrhage surgery and the impact of this condition on patient outcomes.
Material and Methods: Patients >18 years of age with no known renal injury and admitted to the intensive care unit after Fisher Grade IV aneurysmal subarachnoid haemorrhage and surgery between January 2017 and June 2022 were retrospectively analysed. Renal injury was defined as a renal injury occurring within 48 hours of exposure to contrast media in line with the Kidney Disease Improving Global Outcomes criteria.
Results: Among the 85 patients with subarachnoid haemorrhage who received at least one contrast medium, the mean age was 55, and 40% were female. 11.8% of the patients were found to have early acute kidney injury and were non-oliguric. At 48 hours, six, three, and one patients had Stage 1, 2, and 3 injuries, respectively. None of the patients required renal replacement therapy. Patients received a mean of 2 mL/kg/h saline infusion after contrast media administration and had a mean arterial pressure of 93.6 mmHg. There was no association between acute kidney injury and comorbidities, Glasgow coma scale, or APACHE II scores.
Conclusions: The study found that the incidence of contrast-induced acute kidney injury was low and transient in patients followed at the ICU after aneurysmal subarachnoid haemorrhage (Fisher Grade IV) surgery. Adequate hydration and hemodynamic stability were found to be effective in reducing acute kidney injury in these patients.

Keywords

Subarachnoid haemorrhage, intensive care unit, acute kidney injury, contrast media, KDIGO

References

• Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: A meta-analysis. Lancet Neurol. 2009 Jul;8(7):635-42. doi: 10.1016/S1474-4422(09)70126-7.
• Espiner EA, Leikis R, Ferch RD, MacFarlane MR, Bonkowski JA, Frampton CM, Richards AM. The neuro-cardio-endocrine response to acute subarachnoid haemorrhage. Clin Endocrinol (Oxf). 2002 May;56(5):629-35. doi: 10.1046/j.1365-2265.2002.01285.x.
• Eagles ME, Powell MF, Ayling OGS, Tso MK, Macdonald RL. Acute kidney injury after aneurysmal subarachnoid hemorrhage and its effect on patient outcome: an exploratory analysis. J Neurosurg. 2019 Jul 12:1-8. doi: 10.3171/2019.4.JNS19103.
• ACR Manual on contrast media v10.2 [Internet]. Reston (VA): American College of Radiology; 2016. Available at: http://www.acr.org/quality-safety/resources/contrast-manual.
• Lee HG, Kim WK, Yeon JY, Kim JS, Kim KH, Jeon P, Hong SC. Contrast-induced acute kidney ınjury after coil embolization for aneurysmal subarachnoid hemorrhage. Yonsei Med J. 2018 Jan;59(1):107-12. doi: 10.3349/ymj.2018.59.1.107.
• Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002 May;39(5):930-6. doi: 10.1053/ajkd.2002.32766.
• Waikar S, Liu K, Chertow G. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol. 2008 May;3(3):844-61. doi: 10.2215/CJN.05191107.
• Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006 Jan 26;354(4):379-86. doi: 10.1056/NEJMcp050801.
• Geenen RWF, Kingma HJ, van der Molen AJ. Pathophysiology of contrast-induced acute kidney injury. Interv Cardiol Clin. 2014 Jul;3(3):363-7. doi: 10.1016/j.iccl.2014.03.007. E
• Goldfarb S, McCullough PA, McDermott J, Gay SB. Contrast-induced acute kidney injury: specialty-specific protocols for interventional radiology, diagnostic computed tomography radiology, and interventional cardiology. Mayo Clin Proc. 2009 Feb;84(2):170-9. doi: 10.4065/84.2.170.
• Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, Herzog CA, Joannidis M, Kribben A, Levey AS, MacLeod AM, Mehta RL, Murray PT, Naicker S, Opal SM, Schaefer F, Schetz M, Uchino S. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. doi: 10.1038/kisup.2012.1.
• Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, Connolly ES, Mayer SA. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001 Sep;32(9):2012-20. doi: 10.1161/hs0901.095677.
• Kooiman J, Pasha SM, Zondag W, Sijpkens YW, van der Molen AJ, Huisman MV, Dekkers OM. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012 Oct;81(10):2554-61. doi: 10.1016/j.ejrad.2011.11.020.
• Katzberg RW, Lamba R. Contrast-induced nephropathy after intravenous administration: fact or fiction? Radiol Clin North Am. 2009 Sep;47(5):789-800, v. doi: 10.1016/j.rcl.2009.06. 002.
• The National Institute for Health and Care Excellence. Acute kidney injury; Prevention, detection and management up to the point of renal replacement therapy. NICE guideline. Dec 18, 2019. London: Royal College of Physicians. 2019;1-28.
• Jabara R, Gadesam RR, Pendyala LK, Knopf WD, Chronos N, Chen JP, Viel K, King SB 3rd, Manoukian SV. Impact of the definition utilized on the rate of contrast-induced nephropathy in percutaneous coronary intervention. Am J Cardiol. 2009 Jun 15;103(12):1657-62. doi: 10.1016/j.amjcard.2009.02.039.
• de Laforcade L, Bobot M, Bellin MF, Clément O, Grangé S, Grenier N, Wynckel A, Guerrot D. Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging. 2021 Mar;102(3):131-9. doi: 10.1016/j.diii.2021.01.007.
• van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, Clement O, Heinz-Peer G, Stacul F, Webb JAW, Thomsen HS. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2018 Jul;28(7):2845-55. doi: 10.1007/s00330-017-5246-5.
• McDonald JS, Leake CB, McDonald RJ, Gulati R, Katzberg RW, Williamson EE, Kallmes DF. Acute kidney injury after intravenous versus intra-arterial contrast material administration in a paired cohort. Invest Radiol. 2016 Dec;51(12):804-9. doi: 10.1097/RLI.0000000000000298.
• Clec'h C, Razafimandimby D, Laouisset M, Chemouni F, Cohen Y. Incidence and outcome of contrast-associated acute kidney injury in a mixed medical-surgical ICU population: a retrospective study. BMC Nephrol. 2013 Feb 4;14:31. doi: 10.1186/1471-2369-14-31.
• Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005 Dec;36(12):2773-80. doi: 10.1161/01.STR.0000190838.02954.e8.
• Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012 Jun;43(6):1711-37. doi: 10.1161/STR.0b013e3182587839.
• Berg KJ. Nephrotoxicity related to contrast media. Scand J Urol Nephrol. 2000 Oct;34(5):317-22. doi: 10.1080/003655900750048341. 4 McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997 Nov;103(5):368-75. doi: 10.1016/s0002-9343(97)00150-2.
• Rao QA, Newhouse JH. Risk of nephropathy after intravenous administration of contrast material: a critical literature analysis. Radiology. 2006 May;239(2):392-7. doi: 10.1148/radiol.2392050413.
• Kellum JA, Bellomo R, Ronco C. Definition and classification of acute kidney injury. Nephron Clin Pract. 2008;109(4):c182-7. doi: 10.1159/000142926.
• Zhang P, Guan C, Li C, Zhu Z, Zhang W, Luan H, Zhou B, Man X, Che L, Wang Y, Zhao L, Zhang H, Luo C, Xu Y. A visual risk assessment tool for acute kidney injury after intracranial aneurysm clipping surgery. Ren Fail. 2020 Nov;42(1):1093-9. doi: 10.1080/0886022X.2020.1838299.
• McDonald JS, McDonald RJ, Carter RE, Katzberg RW, Kallmes DF, Williamson EE. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology. 2014 Apr;271(1):65-73. doi: 10.1148/radiol.13130775.
• Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013 Sep;268(3):719-28. doi: 10.1148/radiol.13122276.
• Gounden V, Bhatt H, Jialal I. Renal Function Tests. Updated 2022 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507821/.
• Er F, Nia AM, Dopp H, Dahlem KM, Caglayan E, Erdmann E, Gassanov N, Hellmich M, Burst V, Kubacki T, Benzing T. Response to letter regarding article, "Ischemic preconditioning for prevention of contrast medium-induced nephropathy: randomized Pilot RenPro-Trial (Renal Protection Trial)". Circulation. 2013 Apr 2;127(13):e536. doi: 10.1161/circulationaha.112.147587.
• Mueller C. Prevention of contrast-induced nephropathy with volume supplementation. Kidney Int Suppl. 2006 Apr;(100):S16-9. doi: 10.1038/sj.ki.5000369.
• Schönenberger E, Martus P, Bosserdt M, Zimmermann E, Tauber R, Laule M, Dewey M. Kidney injury after intravenous versus intra-arterial contrast agent in patients suspected of having coronary artery disease: A randomized trial. Radiology. 2019 Sep;292(3):664-72. doi: 10.1148/radiol.2019182220.
• Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ehy394.
• McCullough PA, Bertrand ME, Brinker JA, Stacul F. A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. J Am Coll Cardiol. 2006 Aug 15;48(4):692-9. doi: 10.1016/j.jacc.2006.02.073.
• Barrett BJ, Katzberg RW, Thomsen HS, Chen N, Sahani D, Soulez G, Heiken JP, Lepanto L, Ni ZH, Ni ZH, Nelson R. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: a double-blind comparison of iodixanol and iopamidol. Invest Radiol. 2006 Nov;41(11):815-21. doi: 10.1097/01.rli.0000242807.01818.24.
• Carraro M, Malalan F, Antonione R, Stacul F, Cova M, Petz S, Assante M, Grynne B, Haider T, Palma LD, Faccini L. Effects of a dimeric vs a monomeric nonionic contrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial. Eur Radiol. 1998;8(1):144-7. doi: 10.1007/s003300050356.
• Spapen H, Zhang H, Demanet C, Vleminckx W, Vincent JL, Huyghens L. Does N-acetyl-L-cysteine influence cytokine response during early human septic shock? Chest. 1998 Jun;113(6):1616-24. doi: 10.1378/chest.113.6.1616.
• Keays R, Harrison PM, Wendon JA, Forbes A, Gove C, Alexander GJ, Williams R. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991 Oct 26;303(6809):1026-9. doi: 10.1136/bmj.303.6809.1026.
• Fernando B, Marley R, Holt S, Anand R, Harry D, Sanderson P, Smith R, Hamilton G, Moore K. N-acetylcysteine prevents development of the hyperdynamic circulation in the portal hypertensive rat. Hepatology. 1998 Sep;28(3):689-94. doi: 10.1002/hep.510280314.
• Suter PM, Domenighetti G, Schaller MD, Laverrière MC, Ritz R, Perret C. N-acetylcysteine enhances recovery from acute lung injury in man. A randomized, double-blind, placebo-controlled clinical study. Chest. 1994 Jan;105(1):190-4. doi: 10.1378/chest.105.1.190.
• Kekec Z, Seydaoglul G, Sever H, Ozturk F. The effect of antioxidants (N-acetylcysteine and melatonin) on hypoxia due to carbonmonoxide poisoning. Bratisl Lek Listy. 2010;111(4):189-93.
• Tepel M. Acetylcysteine for the prevention of radiocontrast -induced nephropathy. Minerva Cardioangiol. 2003 Oct;51(5):525-30.
• Sůva M, Kala P, Poloczek M, Kaňovský J, Štípal R, Radvan M, Hlasensky J, Hudec M, Brázdil V, Řehořová J. Contrast-induced acute kidney injury and its contemporary prevention. Front Cardiovasc Med. 2022 Dec 6;9:1073072. doi: 10.3389/fcvm.2022.1073072.
• Jo SH. N-acetylcysteine for prevention of contrast-induced nephropathy: A narrative review. Korean Circ J. 2011 Dec;41(12):695-702. doi: 10.4070/kcj.2011.41.12.695.
• Rao QA, Newhouse JH. Risk of nephropathy after intravenous administration of contrast material: a critical literature analysis. Radiology. 2006 May;239(2):392-7. doi: 10.1148/radiol.2392050413.
• Wilhelm-Leen E, Montez-Rath ME, Chertow G. Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol. 2017 Feb;28(2):653-659. doi: 10.1681/ASN.2016010021.
• Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders HJ. Acute kidney injury. Nat Rev Dis Primers. 2021 Jul 15;7(1):52. doi: 10.1038/s41572-021-00284-z.
• Mathiesen T, Edner G, Ulfarsson E, Andersson B. Cerebrospinal fluid interleukin-1 receptor antagonist and tumor necrosis factor-alpha following subarachnoid hemorrhage. J Neurosurg. 1997 Aug;87(2):215-20. doi: 10.3171/jns.1997.87.2.0215.
• Fassbender K, Hodapp B, Rossol S, Bertsch T, Schmeck J, Schütt S, Fritzinger M, Horn P, Vajkoczy P, Kreisel S, Brunner J, Schmiedek P, Hennerici M. Inflammatory cytokines in subarachnoid haemorrhage: association with abnormal blood flow velocities in basal cerebral arteries. J Neurol Neurosurg Psychiatry. 2001 Apr;70(4):534-7. doi: 10.1136/jnnp.70.4.534.
• Lee KH, Lukovits T, Friedman JA. "Triple-H" therapy for cerebral vasospasm following subarachnoid hemorrhage. Neurocrit Care. 2006;4(1):68-76. doi: 10.1385/NCC:4:1:068.
• Rudnick MR, Berns JS, Cohen RM, Goldfarb S. Nephrotoxic risks of renal angiography: contrast media-associated nephrotoxicity and atheroembolism--a critical review. Am J Kidney Dis. 1994 Oct;24(4):713-27. doi: 10.1016/s0272-6386(12)80235-6.
• Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006 Apr;(100):S11-5. doi: 10.1038/sj.ki.5000368.
• Ehrlich ME, Turner HL, Currie LJ, Wintermark M, Worrall BB, Southerland AM. Safety of computed tomographic angiography in the evaluation of patients with acute stroke: A single-center experience. Stroke. 2016 Aug;47(8):2045-50. doi: 10.1161/STROKEAHA.116.013973.