Abstract
Background Historically, there has been a concern that iodinated contrast agents may cause post-contrast nephropathy. However, current guidelines describe that elevated creatinine levels are not an absolute contraindication to CT contrast. The association between renal dysfunction and delay to stroke reperfusion therapy is unclear. This study aimed to determine how renal disease is associated with time to reperfusion therapy.
Methods This retrospective study included 2,960 stroke patients retrieved by ambulance from 2017 to 2022 to all three metropolitan stroke centres in South Australia. Initial eGFR was dichotomised as as ≥30 or < 30ml/min. Hyperacute stroke management timing was dichotomised based on local guideline targets and national key performance indicators. Multivariable logistic regression was conducted to evaluate for associations between the presence of renal disease and time parameters of interest.
Results An initial eGFR of <30ml/min was not significantly associated with the likelihood of symptom-onset-to-door time >90 minutes (OR 0.792, 95%CI 0.563 to 1.116, P = 0.183), door-to-scan time >30 minutes (OR 1.201, 95%CI 0.407 to 3.542, P = 0.741), door-to-needle time <60 minutes (OR 0.502, 95%CI 0.131 to 1.919, P = 0.314) or door-to-groin puncture time <90 minutes (OR 0.694, 95%CI 0.135 to 3.577, P = 0.663).
Conclusion This study demonstrated that there were no significant delays in hyperacute stroke management for patients with renal disease in the participating centres. The centres utilise standardised protocols for acute stroke management, which may have contributed to expedited ‘code stroke’ imaging for renally impaired patients. Further research in other centres is required.
