Evaluation of Acute Kidney Injury and Mortality After Intensive Blood Pressure Control in Patients With Intracerebral Hemorrhage

L. Goodwin Burgess, Nitin Goyal, G. Morgan Jones, Yasser Khorchid, Ali Kerro, Kristina Chapple, Georgios Tsivgoulis, Andrei V. Alexandrov, Jason J. Chang

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We sought to assess the risk of acute kidney injury (AKI) and mortality associated with intensive systolic blood pressure reduction in acute intracerebral hemorrhage. METHODS AND RESULTS: Patients with acute intracerebral hemorrhage had spontaneous cause and symptom onset within 24 hours. We excluded patients with structural causes, coagulopathy, thrombocytopenia, and preexisting end-stage renal disease. We defined AKI using the Acute Kidney Injury Network criteria. Chronic kidney disease status was included in risk stratification and was defined by Kidney Disease Outcomes Quality Initiative staging. Maximum systolic blood pressure reduction was defined over a 12-hour period and dichotomized using receiver operating characteristic curve analysis. Descriptive statistics were done using independent sample t tests, χ2 tests, and Mann-Whitney U tests, whereas multivariable logistic regression analysis was used to evaluate for predictors for AKI and mortality. A total of 448 patients with intracerebral hemorrhage met inclusion criteria. Maximum systolic blood pressure reduction was dichotomized to 90 mm Hg and found to increase the risk of AKI in patients with normal renal function (odds ratio, 2.1; 95% confidence interval, 1.19-3.62; P=0.010) and chronic kidney disease (odds ratio, 3.91; 95% confidence interval, 1.26-12.15; P=0.019). The risk of AKI was not significantly different in normal renal function versus chronic kidney disease groups when adjusted for demographics, presentation characteristics, and medications associated with AKI. AKI positively predicted mortality for patients with normal renal function (odds ratio, 2.41; 95% confidence interval, 1.11-5.22; P=0.026) but not for patients with chronic kidney disease (odds ratio, 3.13; 95% confidence interval, 0.65-15.01; P=0.154). CONCLUSIONS: These results indicate that intensive systolic blood pressure reduction with a threshold >90 mm Hg in patients with acute intracerebral hemorrhage may be an independent predictor for AKI.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume7
Issue number8
DOIs
StatePublished - Apr 13 2018

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Cerebral Hemorrhage
Chronic Renal Insufficiency
Acute Kidney Injury
Homeostasis
Blood Pressure
Hypertension
Kidney
Mortality
Odds Ratio
Confidence Intervals
Kidney Diseases
Nonparametric Statistics
ROC Curve
Thrombocytopenia
Chronic Kidney Failure
Logistic Models
Regression Analysis
Demography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Evaluation of Acute Kidney Injury and Mortality After Intensive Blood Pressure Control in Patients With Intracerebral Hemorrhage. / Burgess, L. Goodwin; Goyal, Nitin; Jones, G. Morgan; Khorchid, Yasser; Kerro, Ali; Chapple, Kristina; Tsivgoulis, Georgios; Alexandrov, Andrei V.; Chang, Jason J.

In: Journal of the American Heart Association, Vol. 7, No. 8, 13.04.2018.

Research output: Contribution to journalArticle

Burgess, L. Goodwin ; Goyal, Nitin ; Jones, G. Morgan ; Khorchid, Yasser ; Kerro, Ali ; Chapple, Kristina ; Tsivgoulis, Georgios ; Alexandrov, Andrei V. ; Chang, Jason J. / Evaluation of Acute Kidney Injury and Mortality After Intensive Blood Pressure Control in Patients With Intracerebral Hemorrhage. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 8.
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abstract = "BACKGROUND: We sought to assess the risk of acute kidney injury (AKI) and mortality associated with intensive systolic blood pressure reduction in acute intracerebral hemorrhage. METHODS AND RESULTS: Patients with acute intracerebral hemorrhage had spontaneous cause and symptom onset within 24 hours. We excluded patients with structural causes, coagulopathy, thrombocytopenia, and preexisting end-stage renal disease. We defined AKI using the Acute Kidney Injury Network criteria. Chronic kidney disease status was included in risk stratification and was defined by Kidney Disease Outcomes Quality Initiative staging. Maximum systolic blood pressure reduction was defined over a 12-hour period and dichotomized using receiver operating characteristic curve analysis. Descriptive statistics were done using independent sample t tests, χ2 tests, and Mann-Whitney U tests, whereas multivariable logistic regression analysis was used to evaluate for predictors for AKI and mortality. A total of 448 patients with intracerebral hemorrhage met inclusion criteria. Maximum systolic blood pressure reduction was dichotomized to 90 mm Hg and found to increase the risk of AKI in patients with normal renal function (odds ratio, 2.1; 95{\%} confidence interval, 1.19-3.62; P=0.010) and chronic kidney disease (odds ratio, 3.91; 95{\%} confidence interval, 1.26-12.15; P=0.019). The risk of AKI was not significantly different in normal renal function versus chronic kidney disease groups when adjusted for demographics, presentation characteristics, and medications associated with AKI. AKI positively predicted mortality for patients with normal renal function (odds ratio, 2.41; 95{\%} confidence interval, 1.11-5.22; P=0.026) but not for patients with chronic kidney disease (odds ratio, 3.13; 95{\%} confidence interval, 0.65-15.01; P=0.154). CONCLUSIONS: These results indicate that intensive systolic blood pressure reduction with a threshold >90 mm Hg in patients with acute intracerebral hemorrhage may be an independent predictor for AKI.",
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AU - Khorchid, Yasser

AU - Kerro, Ali

AU - Chapple, Kristina

AU - Tsivgoulis, Georgios

AU - Alexandrov, Andrei V.

AU - Chang, Jason J.

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AB - BACKGROUND: We sought to assess the risk of acute kidney injury (AKI) and mortality associated with intensive systolic blood pressure reduction in acute intracerebral hemorrhage. METHODS AND RESULTS: Patients with acute intracerebral hemorrhage had spontaneous cause and symptom onset within 24 hours. We excluded patients with structural causes, coagulopathy, thrombocytopenia, and preexisting end-stage renal disease. We defined AKI using the Acute Kidney Injury Network criteria. Chronic kidney disease status was included in risk stratification and was defined by Kidney Disease Outcomes Quality Initiative staging. Maximum systolic blood pressure reduction was defined over a 12-hour period and dichotomized using receiver operating characteristic curve analysis. Descriptive statistics were done using independent sample t tests, χ2 tests, and Mann-Whitney U tests, whereas multivariable logistic regression analysis was used to evaluate for predictors for AKI and mortality. A total of 448 patients with intracerebral hemorrhage met inclusion criteria. Maximum systolic blood pressure reduction was dichotomized to 90 mm Hg and found to increase the risk of AKI in patients with normal renal function (odds ratio, 2.1; 95% confidence interval, 1.19-3.62; P=0.010) and chronic kidney disease (odds ratio, 3.91; 95% confidence interval, 1.26-12.15; P=0.019). The risk of AKI was not significantly different in normal renal function versus chronic kidney disease groups when adjusted for demographics, presentation characteristics, and medications associated with AKI. AKI positively predicted mortality for patients with normal renal function (odds ratio, 2.41; 95% confidence interval, 1.11-5.22; P=0.026) but not for patients with chronic kidney disease (odds ratio, 3.13; 95% confidence interval, 0.65-15.01; P=0.154). CONCLUSIONS: These results indicate that intensive systolic blood pressure reduction with a threshold >90 mm Hg in patients with acute intracerebral hemorrhage may be an independent predictor for AKI.

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