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2018 ; 7
(8
): ä Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Evaluation of Acute Kidney Injury and Mortality After Intensive Blood Pressure
Control in Patients With Intracerebral Hemorrhage
#MMPMID29654207
Burgess LG
; Goyal N
; Jones GM
; Khorchid Y
; Kerro A
; Chapple K
; Tsivgoulis G
; Alexandrov AV
; Chang JJ
J Am Heart Assoc
2018[Apr]; 7
(8
): ä PMID29654207
show ga
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, ?(2) 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.