Background: Historically, renal dysfunction has contraindicated multimodal CT stroke imaging, due to fears of contrast nephropathy. However, guided by recent evidence demonstrating a lack of significant harm, current guidelines no longer preclude iodinated contrast administration in this setting. While all South Australian Stroke centres explicitly recommend expedited multimodal CTP in patients with Chronic Kidney Disease (CKD), it is uncertain whether contrast nephropathy concerns may still delay stroke multimodal imaging and treatments.
Aims: This study aimed to determine whether patients with CKD suffered delay in stroke reperfusion assessment and 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 ≥30 or < 30ml/min (stage 4-5 (CKD)). 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: Of 2960 patients, 155 (5.2%) had Stage 4-5 CKD. This 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 South Australian metropolitan stroke patients with stage 4-5 CKD did not experience significant delays in hyperacute stroke management. Protocolised care may abrogate potential treatment delays in patients with advanced CKD.