Serum Electrolytes and Contrast-Induced Nephropathy in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

This retrospective cohort study is designed to evaluate the association between serum electrolyte levels and the development of contrast-induced acute kidney injury (CI-AKI) in patients undergoing endovascular therapy (EVT) for acute ischemic stroke.

Endovascular treatment has become a standard of care for acute ischemic stroke; however, the use of iodinated contrast media carries a risk of nephrotoxicity. Contrast-induced acute kidney injury remains a clinically significant complication and is associated with prolonged hospitalization, increased healthcare costs, and higher mortality rates. Although several well-established risk factors for CI-AKI have been identified, including baseline renal dysfunction, diabetes mellitus, and contrast volume, the role of serum electrolyte imbalances has not been clearly defined.

Electrolyte disturbances may influence renal perfusion, tubular function, and systemic hemodynamics, potentially contributing to the pathophysiology of CI-AKI. Therefore, identifying electrolyte-related risk factors may help improve risk stratification and guide preventive strategies in high-risk populations.

In this study, patients who underwent EVT between 2018 and 2026 will be included. Prospectively collected clinical data will be analyzed retrospectively. Patients will be divided into two groups based on the development of CI-AKI, defined according to changes in serum creatinine levels following contrast exposure.

Comparative analyses will be performed between patients with and without CI-AKI to identify potential predictors. Multivariate regression analysis may be used to determine independent risk factors associated with CI-AKI development.

The findings of this study are expected to provide clinically relevant insights into the role of electrolyte balance in the development of CI-AKI and may contribute to improved peri-procedural risk assessment and patient management strategies in acute ischemic stroke populations undergoing endovascular therapy.

Inclusion criteria

• Adults aged 18 years or older
• Patients diagnosed with acute ischemic stroke
• Patients who underwent endovascular therapy for acute ischemic stroke between 2018 and 2026
• Patients with a baseline NIHSS score of 6 or higher
• Patients who received iodinated contrast medium during the endovascular procedure
• Patients managed under general anesthesia
• Patients with available pre-procedural and post-procedural serum creatinine measurements sufficient to assess contrast-induced acute kidney injury

Exclusion criteria

• Age younger than 18 years
• Pre-existing acute kidney injury or chronic kidney disease meeting KDIGO stage 1-3 before endovascular therapy
• APACHE score greater than 25 at the time of the procedure
• Known allergy or hypersensitivity to iodinated contrast media
• Exposure to iodinated contrast media within the previous 2 weeks
• Use of nephrotoxic medications within the previous 2 weeks
• History of myocardial infarction or previous stroke
• Use of vasopressor/inotropic agents such as dopamine at the time of the procedure
• Systemic steroid use at the time of the procedure
• Incomplete medical records or missing laboratory data required for evaluation of CI-AKI