Impact of Admission Hypertension on Rates of Acute Kidney Injury in Intracerebral Hemorrhage Treated with Intensive Blood Pressure Control

Hewgley, Hannah; Turner, Steven C.; Vandigo, Joseph; Marler, Jacob; Snyder, Heather; Chang, Jason J.; Jones, G. Morgan

doi:10.1007/s12028-017-0488-2

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…Organ function decreases with age, and is accompanied by the onset of arteriosclerosis, diabetes and hypertension, which may increase susceptibility to AKI. We revealed that hypertension was one of the independent risk factors for AKI in RM patients; likewise, a previous study reported that diagnosed hypertension was an independent risk factor for AKI in patients with chronic kidney disease or intracerebral hemorrhage [19,20]. In addition, a retrospective study of 43,611 patients demonstrated that the occurrence of AKI in hospitalized, previously normotensive adults was independently associated with increased blood pressure during the first 2 years after discharge [21].…”

Section: Discussionsupporting

confidence: 67%

Risk factors for acute kidney injury among patients with rhabdomyolysis

Yang

Zhou

Wang

et al. 2020

Preprint

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Background: Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of AKI defined by the Kidney Disease Improving Global Outcomes criteria and in-hospital mortality. Methods: We performed a retrospective study of patients with creatine kinase levels >1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. Results: For the 329 patients included in our study, the incidence of AKI was 61.4%, and the overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P<0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to AKI. The risk factors for the occurrence of AKI among RM patients included age ≥60 years (OR=3.070), chronic alcoholism (OR=3.256), hypertension (OR=4.252), multiple organ dysfunction syndrome (MODS; OR=7.244), high levels of white blood cell count (OR=1.047) and elevated serum phosphorus (OR=5.526). Age ≥60 years (OR=3.188), MODS (OR=2.262), diabetes (OR=2.746) and elevated prothrombin time (OR=1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. Conclusions: AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

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Section: Discussionsupporting

confidence: 67%

Risk factors for acute kidney injury among patients with rhabdomyolysis

Yang

Zhou

Wang

et al. 2020

Preprint

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“…However, we derived this definition from other studies in those with severe neurologic injuries that have recently been published in the literature. [32][33][34] Our results should not be generalized to patients with CKD or those who present with an AKI. We are also unable to report data related to overall fluid status due to limitations in abstracting this retrospectively from the electronic medication record.…”

Section: Discussionmentioning

confidence: 88%

An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

Haller

Smetana

Erdman

et al. 2020

The Neurohospitalist

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Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.

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“…This could explain the higher incidence of renal adverse events found in the study . Subsequent trials shed further light on the safety of acute BP lowering in patients with ICH . One retrospective analysis showed that an SBP reduction of more than 90 mm Hg increases the risk of acute kidney injury (AKI) irrespective of previous kidney function .…”

Section: Blood Pressure Control In Neurologic Emergenciesmentioning

confidence: 84%

“…One retrospective analysis showed that an SBP reduction of more than 90 mm Hg increases the risk of acute kidney injury (AKI) irrespective of previous kidney function . Another analysis evaluated the impact of the degree of admission hypertension on renal outcomes in this patient population . Patients with severe hypertension (SBP of 220 mm Hg or higher) were found to have higher rates of AKI compared with patients with mild or moderate admission hypertension.…”

Section: Blood Pressure Control In Neurologic Emergenciesmentioning

confidence: 99%

“…39 Subsequent trials shed further light on the safety of acute BP lowering in patients with ICH. 40,41 One retrospective analysis showed that an SBP reduction of more than 90 mm Hg increases the risk of acute kidney injury (AKI) irrespective of previous kidney function. 40 Another analysis evaluated the impact of the degree of admission hypertension on renal outcomes in this patient population.…”

Section: Intracerebral Hemorrhagementioning

confidence: 99%

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Acute Blood Pressure Management in Neurocritically Ill Patients

Levasseur-Franklin

Makii

2019

Pharmacotherapy

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Optimal blood pressure (BP) management is controversial in neurocritically ill patients due to conflicting concerns of worsening ischemia with decreased BP versus cerebral edema and increased intracranial pressure with elevated BP. In addition, high‐quality evidence is lacking regarding optimal BP goals in patients with most of these conditions. This review summarizes guideline recommendations and examines the literature for BP management in patients with ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury.

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Impact of Admission Hypertension on Rates of Acute Kidney Injury in Intracerebral Hemorrhage Treated with Intensive Blood Pressure Control

Abstract: Our study observed higher rates of AKI in patients presenting with severe hypertension. Further research is needed to determine the most appropriate strategies for managing blood pressure in ICH patients presenting with higher SBP.

Cited by 11 publications

References 20 publications

Risk factors for acute kidney injury among patients with rhabdomyolysis

Risk factors for acute kidney injury among patients with rhabdomyolysis

An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

Acute Blood Pressure Management in Neurocritically Ill Patients

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