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Abstract
Aims Endovascular therapy (EVT) is a highly effective stroke treatment, but it requires the administration of contrast media which puts patients at risk of acute kidney injury (AKI). AKI is associated with increased morbidity and mortality in cardiovascular patients.
Methods PubMed, Scopus, ISI and the Cochrane Library were systematically searched for observational and experimental studies assessing the occurrence of AKI in adult acute stroke patients submitted to EVT. Two independent reviewers collected study data regarding study setting, period, source of data, and AKI definition and predictors, the outcomes of interest being AKI incidence and 90-day death or dependency (modified Rankin Scale score ≥3). These outcomes were pooled using random effect models, and heterogeneity was measured using the I2 statistic.
Results 22 studies were identified and included in the analysis, involving 32 034 patients. Pooled incidence of AKI was 7% (95% CI 5% to 10%), but heterogeneity was high across studies (I2=98%), and not accounted for by the definition of AKI used. The most frequently reported AKI predictors were impaired baseline renal function (5 studies) and diabetes (3 studies); 3 studies (2103 patients) reported data on death and 4 studies (2424 patients) reported data on dependency. Overall, AKI was associated with both outcomes, with ORs of 6.21 (95% CI 3.52 to 10.96) and 2.86 (95% CI 1.88 to 4.37), respectively. Heterogeneity was low for both analyses (I2=0%).
Conclusions AKI affects 7% of acute stroke patients submitted to EVT and identifies a subgroup of patients for which treatment outcomes are suboptimal, with an increased risk of death and dependency.
- Stroke
- Thrombectomy
- Complication
Data availability statement
Data are available upon reasonable request. The datasets generated and analyzed for the current study are available from the corresponding author upon reasonable request.
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Data availability statement
Data are available upon reasonable request. The datasets generated and analyzed for the current study are available from the corresponding author upon reasonable request.
Footnotes
Contributors MO and TG designed the study protocol, which was approved by all authors. MO and TG performed the study search and data collection. AR, FB, and VA performed the statistical analysis. All authors interpreted the results. MO and TG wrote the first draft of the manuscript, which was reviewed and approved by all authors. All authors had access to the study data. MO acts as a guarantor and accepts full responsibility for the the conduct of the study and decision to submit the manuscript for publication, on behalf of all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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