Systolic Blood Pressure Reduction and Acute Kidney Injury in Intracerebral Hemorrhage

Abstract

Background and Purpose: We determined the rates and predictors of acute kidney injury (AKI) and renal adverse events (AEs), and effects of AKI and renal AEs on death or disability in patients with intracerebral hemorrhage. Methods: We analyzed data from a multicenter trial which randomized 1000 intracerebral hemorrhage patients with initial systolic blood pressure ≥180 mm Hg to intensive (goal 110–139 mm Hg) over standard (goal 140–179 mm Hg) systolic blood pressure reduction within 4.5 hours of symptom onset. AKI was identified by serial assessment of daily serum creatinine for 3 days post randomization. Results: AKI and renal AEs were observed in 149 patients (14.9%) and 65 patients (6.5%) among 1000 patients, respectively. In multivariate analysis, the higher baseline serum creatinine (≥110 μmol/L) was associated with AKI (odds ratio 2.4 [95% CI, 1.2–4.5]) and renal AEs (odds ratio 3.1 [95% CI, 1.2–8.1]). Higher area under the curve for intravenous nicardipine dose was associated with AKI (odds ratio 1.003 [95% CI, 1.001–1.005]) and renal AEs (odds ratio 1.003 [95% CI, 1.001–1.006]). There was a higher risk to death (relative risk 2.6 [95% CI, 1.6–4.2]) and death or disability (relative risk 1.5 [95% CI, 1.3–1.8]) at 90 days in patients with AKI but not in those with renal AEs. Conclusions: Intracerebral hemorrhage patients with higher baseline serum creatinine and those receiving higher doses of nicardipine were at higher risk for AKI and renal AEs. Occurrence of AKI was associated higher rates of death or disability at 3 months. Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT01176565.

Enhancing Robustness of Machine Learning Integration With Routine Laboratory Blood Tests to Predict Inpatient Mortality After Intracerebral Hemorrhage

“…For example, in our model, blood glucose derived from labs is the most important feature for predicting ICH mortality during hospitalization, as considerable previous studies have supported this finding ( 28 – 30 ). Some of which, including creatinine ( 31 ), white blood cell count ( 32 ), prothrombin time ( 33 ), chlorine ( 34 ), potassium ( 35 ), percentage of lymphocytes ( 36 ), red blood cell distribution width ( 37 ), uric acid ( 38 ), and phosphorus ( 39 ) also correspond with previously investigated risk factors from previous clinical studies. These features were presented in nearly two-thirds of the overall selecting variables (8 out of 13), suggesting our model is reliable.…”

Impact of Renal Impairment on Intensive Blood-Pressure–Lowering Therapy and Outcomes in Intracerebral Hemorrhage

“…As a result, AKI was not the mediator between treatment and poor outcomes but the predictor for poor outcomes, as already reported in the entire ATACH-2 population. 30 In this context, because the brain and kidneys share similar susceptibility to vascular injury, 20 , 31 patients with decreased eGFR may be more susceptible to restricted cerebral perfusion by aggressive SBP lowering, resulting in delayed functional recovery. However, further studies are warranted to elucidate the mechanism.…”

Post-Contrast Acute Kidney Injury after Acute Stroke—Insights from a German Tertiary Care Center

“…The higher overall rates of AKI in this meta-analysis are not surprising, given that the definition of PC-AKI that was used in our study only considers the first 3 days after CM exposure. In general, patients with ICH are at particular risk for AKI, and this is likely due to a series of underlying mechanisms, including chronic hypertension and hypertensive kidney disease paired with antihypertensive treatment [ 16 , 17 ].…”