Letter by Malhotra et al Regarding Article, “Neurons Over Nephrons: Systematic Review and Meta-Analysis of Contrast-Induced Nephropathy in Patients With Acute Stroke”
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To the Editor:
We thank the authors Brinjikji et al for their study on contrast-induced nephropathy (CIN) in acute stroke patients.1 The study concludes that iodinated contrast for computed tomographic (CT) angiography/CT perfusion does not increase the risk of acute kidney injury (AKI) in patients with acute stroke. We have a few observations and questions. Do the authors have an explanation as to why AKI incidence was lower in patients who received contrast as noted in the meta-analysis results (2.3 versus 6.3% in case-controlled studies)?
Preexisting renal dysfunction is the most important risk factor for development of CIN.2 Baseline creatinine is not reliable enough to identify patients at risk for CIN, and creatinine clearance is more reliable to assess renal function.3 Closer scrutiny of the case-controlled studies included …