Abstract 201: Prevalence of Unsuspected Renal Insufficiency in Stroke Patients Presenting to the Emergency Department: A Population-Based Assessment
Background: CT Angiography (CTA) provides timely information in patients with suspected acute ischemic stroke (AIS) or intracranial hemorrhage (ICH) regarding presence of arterial occlusion, vascular anomalies or ongoing hemorrhage. Although uncommon and typically transient, risk of contrast nephropathy can deter use of CTA in acute management of these patients, potentially delaying diagnosis and treatment. Using a nationally-representative, population-based epidemiologic database of patients with AIS and ICH, we determined the prevalence of chronic (CRI) and unsuspected renal insufficiency (URI).
Methods: All patients with AIS and ICH who presented in 2010 to an emergency department within Greater Cincinnati / Northern Kentucky were included (n=2348). Charts were retrospectively reviewed, and characteristics including age, race, gender, hypertension (HTN), diabetes (DM), tobacco use, CRI, and serum creatinine (sCr) on presentation were abstracted. We determined the proportion of patients with CRI and those with URI (sCr ≥ 1.5 with no history of CRI). URI cases were further stratified as intermediate (sCr = 1.5-2.0) or severe (sCr > 2.0). Multivariable analysis determined independent predictors of URI.
Results: There were 2049 AIS patients and 299 ICH patients in 2010. Overall, 409 patients had sCr ≥ 1.5 (17.4%) and 186 patients had sCr > 2.0 (7.9%). 348 patients reported CRI (14.8%). URI was noted in 166 patients (8.3% of those without CRI; 8.5% in AIS and 7.3% in ICH patients), and 40 patients had severe URI (2% of those without CRI). Independent predictors of URI included age (OR 1.13 per 5 years, 95% CI 1.06-1.20), HTN (OR 1.73, 95% CI 1.16-2.64), black race (OR 2.94, 95% CI 2.06-4.19), and male gender (OR 2.13, 95% CI 1.53-2.99).
Conclusions: In our population, 17.4% of patients with AIS or ICH had an initial sCr ≥ 1.5. This elevation in sCr, high enough in many institutions to preclude CTA, was unsuspected in 8.3% of patients who had no history of CRI, and sCr > 2.0 was unsuspected in 2%. Predictors were as expected: age, HTN, black race and male gender. Estimates of CRI and URI among stroke patients should be considered, along with published rates and severity of contrast nephropathy, to guide future cost-benefit analyses of CTA in management of acute stroke.
Author Disclosures: A.W. Grossman: None. J.C. Khoury: Research Grant; Significant; NS30678. K. Alwell: Research Grant; Significant; NS30678. C.J. Moomaw: Research Grant; Significant; NS30678. P. Khatri: Honoraria; Modest; Academic Grand Rounds (paid to Dept). Other; Modest; Taylor and Francis-Stroke Ctr Handbook book royalties (paid to Dept). Research Grant; Significant; NIH/NINDS (IMS III, NSTN NCC/RCC). Other Research Support; Significant; Significant; Genentech-PRISMS Trial PI (paid to Dept), Penumbra-THERAPY Trial PI (paid to Dept). D. Woo: Research Grant; Modest; NS30678. M. Flaherty: Research Grant; Modest; NS30678. S. Ferioli: Research Grant; Modest; NS30678. J. Mackey: None. S. Martini: Research Grant; Modest; NS30678. F. de los Rios la Rosa: None. B.M. Kissela: Research Grant; Significant; NS30678. D.O. Kleindorfer: Research Grant; Significant; NS30678. Speakers' Bureau; Modest; Genentech.
- © 2014 by American Heart Association, Inc.