The Impact of Acute Kidney Injury on Fatality of Ischemic Stroke from a Hospital-based Population in Joinville, Brazil

Overview

Journal J Bras Nefrol

Specialty Nephrology

Date 2019 Oct 30

PMID 31661544

Citations 1

Authors

Helbert do Nascimento Lima

Tais Saibel

Gisele Colato

Norberto Luiz Cabral

Affiliations

Soon will be listed here.

Abstract

Introduction: The occurrence of acute kidney injury (AKI) after ischemic stroke has been associated to a worse prognosis. There is a lack of Brazilian studies evaluating this issue. This study aimed to describe the impact of AKI after a first-ever ischemic stroke in relation to fatality rate in 30 days.

Methods: This was a retrospective hospital-based cohort. We included patients who had their first ischemic stroke between January to December 2015. AKI was defined by an increase of serum creatinine in relation to baseline value at admission ≥ 0.3 mg/dL or a rise in serum creatinine level by 1.5 times the baseline value at any point in the first week after admission. We performed a univariate and multivariate analysis to evaluate the presence of AKI with fatality in 30 days.

Results: The final study population (n=214) had mean age of 66.46 ± 13.73 years, 48.1% were men, the mean NIHSS was 6.33 ± 6.27 and 20 (9.3%) presented AKI. Patients with AKI were older, had a higher score on the NIHSS, and had higher creatinine values on hospital discharge. The 30-day mortality was higher in the AKI subgroup compared to non-AKI (35% vs. 6.2%, p < 0.001). AKI was an independent predictor of fatality after an ischemic stroke but limited by severity of stroke (NIHSS).

Conclusion: The presence of AKI is an important complication after ischemic stroke. Despite its impact on 30-day fatality, the predictive strength of AKI was limited by the severity of stroke.

Citing Articles

Renal safety evaluation of aspirin plus edaravone in patients with ischaemic stroke: a retrospective cohort study.

Yang H, Yin W, Liu K, Liu M, Zuo X BMJ Open. 2022; 12(4):e055469.

PMID: 35440453 PMC: 9020313. DOI: 10.1136/bmjopen-2021-055469.

References

Covic A, Schiller A, Mardare N, Petrica L, Petrica M, Mihaescu A . The impact of acute kidney injury on short-term survival in an Eastern European population with stroke. Nephrol Dial Transplant. 2007; 23(7):2228-34. DOI: 10.1093/ndt/gfm591. View

Kong F, Tao W, Hao Z, Liu M . Predictors of one-year disability and death in Chinese hospitalized women after ischemic stroke. Cerebrovasc Dis. 2009; 29(3):255-62. DOI: 10.1159/000267852. View

Saposnik G, Guzik A, Reeves M, Ovbiagele B, Johnston S . Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100. Neurology. 2012; 80(1):21-8. PMC: 3589202. DOI: 10.1212/WNL.0b013e31827b1ace. View

Nadkarni G, Patel A, Konstantinidis I, Mahajan A, Agarwal S, Kamat S . Dialysis Requiring Acute Kidney Injury in Acute Cerebrovascular Accident Hospitalizations. Stroke. 2015; 46(11):3226-31. DOI: 10.1161/STROKEAHA.115.010985. View

Fonarow G, Saver J, Smith E, Broderick J, Kleindorfer D, Sacco R . Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc. 2012; 1(1):42-50. PMC: 3487316. DOI: 10.1161/JAHA.111.000034. View

Tsagalis G, Akrivos T, Alevizaki M, Manios E, Theodorakis M, Laggouranis A . Long-term prognosis of acute kidney injury after first acute stroke. Clin J Am Soc Nephrol. 2009; 4(3):616-22. PMC: 2653666. DOI: 10.2215/CJN.04110808. View

Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F . The global stroke initiative. Lancet Neurol. 2004; 3(7):391-3. DOI: 10.1016/S1474-4422(04)00800-2. View

Koton S, Schneider A, Rosamond W, Shahar E, Sang Y, Gottesman R . Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014; 312(3):259-68. DOI: 10.1001/jama.2014.7692. View

Englberger L, Suri R, Li Z, Casey E, Daly R, Dearani J . Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care. 2011; 15(1):R16. PMC: 3222049. DOI: 10.1186/cc9960. View

10.

Zorrilla-Vaca A, Ziai W, Connolly Jr E, Geocadin R, Thompson R, Rivera-Lara L . Acute Kidney Injury Following Acute Ischemic Stroke and Intracerebral Hemorrhage: A Meta-Analysis of Prevalence Rate and Mortality Risk. Cerebrovasc Dis. 2017; 45(1-2):1-9. DOI: 10.1159/000479338. View

11.

Gadalean F, Simu M, Parv F, Vorovenci R, Tudor R, Schiller A . The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis. PLoS One. 2017; 12(10):e0185589. PMC: 5645137. DOI: 10.1371/journal.pone.0185589. View

12.

Smith E, Shobha N, Dai D, Olson D, Reeves M, Saver J . A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke. J Am Heart Assoc. 2013; 2(1):e005207. PMC: 3603253. DOI: 10.1161/JAHA.112.005207. View

13.

Thomas M, Blaine C, Dawnay A, Devonald M, Ftouh S, Laing C . The definition of acute kidney injury and its use in practice. Kidney Int. 2014; 87(1):62-73. DOI: 10.1038/ki.2014.328. View

14.

Hatano S . Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976; 54(5):541-53. PMC: 2366492. View

15.

Mehta R, Kellum J, Shah S, Molitoris B, Ronco C, Warnock D . Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007; 11(2):R31. PMC: 2206446. DOI: 10.1186/cc5713. View

16.

Khatri M, Himmelfarb J, Adams D, Becker K, Longstreth W, Tirschwell D . Acute kidney injury is associated with increased hospital mortality after stroke. J Stroke Cerebrovasc Dis. 2012; 23(1):25-30. PMC: 3507321. DOI: 10.1016/j.jstrokecerebrovasdis.2012.06.005. View

17.

Ostermann M, Chang R . Challenges of defining acute kidney injury. QJM. 2010; 104(3):237-43. DOI: 10.1093/qjmed/hcq185. View

18.

Wu V, Wu P, Wu C, Huang T, Chang C, Tsai P . The impact of acute kidney injury on the long-term risk of stroke. J Am Heart Assoc. 2014; 3(4). PMC: 4310379. DOI: 10.1161/JAHA.114.000933. View

19.

Bonita R, Anderson C, Broad J, Jamrozik K, Stewart-Wynne E, Anderson N . Stroke incidence and case fatality in Australasia. A comparison of the Auckland and Perth population-based stroke registers. Stroke. 1994; 25(3):552-7. DOI: 10.1161/01.str.25.3.552. View

20.

Tsagalis G, Akrivos T, Alevizaki M, Manios E, Stamatellopoulos K, Laggouranis A . Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrol Dial Transplant. 2008; 24(1):194-200. DOI: 10.1093/ndt/gfn471. View