Acute Renal Failure Is Associated With Higher Death and Disability in Patients With Acute Ischemic Stroke

Abstract

ResultsA total of 372 223 (5.3%) patients admitted with AIS had ARF. Dialysis was required in 2364 (0.6%) of 372 223 patients. Patients with ARF were older (mean age, 74±28 versus 72±31 years; P<0.0001) and predominantly men (52%; P<0.0001). Comorbid conditions, such as hypertension, diabetes mellitus, atrial fibrillation, and congestive heart failure, were significantly higher in patients with ARF (Table I in the online-only Background and Purpose-Acute renal failure (ARF) in setting of acute ischemic stroke (AIS) is associated with worse outcome. We sought to determine the prevalence of ARF and effect on outcomes of patients with AIS. Methods-Data from all patients admitted to US hospitals between 2002 and 2010 with a primary discharge diagnosis of ischemic stroke and secondary diagnosis of ARF were included. The effect of ARF on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. Results-Of 7 068 334 patients with AIS, 372 223 (5.3%) had ARF during hospitalization. Dialysis was required in 2364 (0.6%) of 372 223 patients. Patients with AIS with ARF had higher rates of moderate to severe disability (41.3% versus 30%; P<0.0001), intracerebral hemorrhage (1.0% versus 0.5%; P<0.0001), and in-hospital mortality (8.4% versus 2.9%; P<0.0001) compared with those without ARF. After adjusting for confounding factors, patients with AIS with ARF had higher odds of moderate to severe disability (odds ratio, 1.3; 95% confidence interval, 1.3-1.4; P<0.0001), intracerebral hemorrhage (odds ratio, 1.4; 95% confidence interval, 1.3-1.6; P<0.0001), and death (odds ratio, 2.2; 95% confidence interval, 2.0-2.2; P<0.0001). Conclusions-ARF in patients with AIS is associated with significantly higher rates of moderate to severe disability at discharge and in-hospital mortality.

Worse In-Hospital Outcomes in Patients with Transient Ischemic Attack in Association with Acute Kidney Injury: Analysis of Nationwide In-Patient Sample

“…Our study findings are similar to the previously published literature on the outcomes of acute ischemic stroke with the accompanying AKI [6]. In this study, higher odds of mortality, disability, mean hospital charges and increased length of stay were reported; these factors are quite similar to our findings in a different cohort of patients.…”

“…AKI can be seen in 5.3% of patients with ischemic stroke [6]. In our study, incidence of AKI was around 3.8% in patients admitted with TIA.…”

“…In our study, incidence of AKI was around 3.8% in patients admitted with TIA. Nearly 0.06% of the patients in the AKI group required dialysis, which is lower than the previously reported incidence of 0.6% in the setting of ischemic stroke [6]. It should be noted that our study only looked at the incidence of AKI in the hospitalized patients and did not capture patients who were managed in TIA clinics or observation units.…”

Acute Kidney Injury Following Acute Ischemic Stroke and Intracerebral Hemorrhage: A Meta-Analysis of Prevalence Rate and Mortality Risk

“…In addition to the threefold increase in mortality after AIS, acute kidney failure has been associated, after adjusting for confounding factors, with higher odds of moderate-to-severe disability and with ICH [23]. Furthermore, none of the studies in this meta-analysis included patients with acute kidney failure requiring dialysis, which may be associated with higher mortality.…”

Dialysis Requiring Acute Kidney Injury in Acute Cerebrovascular Accident Hospitalizations

“…15 Multivariate analyses stratified by stroke type demonstrated that AKI was associated with significantly increased hospital mortality from ischemic stroke but not ICH. In a subsequent cross-sectional study from NIS, Saeed et al 16 examined the effect of AKI after AIS on risk of ICH and disability at discharge. Patients (5.3%) admitted with AIS had AKI, as defined by administrative codes.…”