Minesh Khatri1, Jonathan Himmelfarb2, Derk Adams3, Kyra Becker3, W T Longstreth3, David L Tirschwell3. 1. Division of Nephrology, Department of Internal Medicine, Columbia University, New York, New York. Electronic address: minesh.khatri@gmail.com. 2. Division of Nephrology, Department of Internal Medicine, University of Washington, Seattle, Washington. 3. Department of Neurology, University of Washington, Seattle, Washington.
Abstract
BACKGROUND: Acute kidney injury (AKI) is common and is associated with poor clinical outcomes. Information about the incidence of AKI and its effect on stroke outcomes is limited. METHODS: Data were analyzed from a registry of subjects with ischemic stroke and intracerebral hemorrhage (ICH) hospitalized at a single academic medical center. Admission creatinine was considered to be the baseline. AKI was defined as a creatinine increase during hospitalization of 0.3 mg/dL or a percentage increase of at least 50% from baseline. Multivariate logistic regression models were created for both stroke types, with hospital mortality as the outcome. Covariates included gender, race, age, admission creatinine, National Institutes of Health Stroke Scale score at admission, the performance of a contrast-enhanced computed tomographic scan of the head and neck, and medical comorbidities. RESULTS: There were 528 cases of ischemic stroke with 70 deaths (13%), and 829 cases of ICH with 268 deaths (32%). The mean age was 64 years; 56% of patients were men and 71% were white. AKI complicated 14% of ischemic stroke and 21% of ICH hospitalizations. In multivariate analysis stratified by stroke type, AKI was associated with increased hospital mortality from ischemic stroke (odds ratio [OR] 3.08; 95% confidence interval [CI] 1.49-6.35) but not ICH (OR 0.82; 95% CI 0.50-1.35), except for those surviving at least 2 days (OR 2.11; 95% CI 1.18-3.77). CONCLUSIONS: AKI occurs frequently after stroke and is associated with increased hospital mortality. Additional studies are needed to establish if the association is causal and if measures to prevent AKI would result in decreased mortality.
BACKGROUND:Acute kidney injury (AKI) is common and is associated with poor clinical outcomes. Information about the incidence of AKI and its effect on stroke outcomes is limited. METHODS: Data were analyzed from a registry of subjects with ischemic stroke and intracerebral hemorrhage (ICH) hospitalized at a single academic medical center. Admission creatinine was considered to be the baseline. AKI was defined as a creatinine increase during hospitalization of 0.3 mg/dL or a percentage increase of at least 50% from baseline. Multivariate logistic regression models were created for both stroke types, with hospital mortality as the outcome. Covariates included gender, race, age, admission creatinine, National Institutes of Health Stroke Scale score at admission, the performance of a contrast-enhanced computed tomographic scan of the head and neck, and medical comorbidities. RESULTS: There were 528 cases of ischemic stroke with 70 deaths (13%), and 829 cases of ICH with 268 deaths (32%). The mean age was 64 years; 56% of patients were men and 71% were white. AKI complicated 14% of ischemic stroke and 21% of ICH hospitalizations. In multivariate analysis stratified by stroke type, AKI was associated with increased hospital mortality from ischemic stroke (odds ratio [OR] 3.08; 95% confidence interval [CI] 1.49-6.35) but not ICH (OR 0.82; 95% CI 0.50-1.35), except for those surviving at least 2 days (OR 2.11; 95% CI 1.18-3.77). CONCLUSIONS: AKI occurs frequently after stroke and is associated with increased hospital mortality. Additional studies are needed to establish if the association is causal and if measures to prevent AKI would result in decreased mortality.
Authors: Eric A J Hoste; Norbert H Lameire; Raymond C Vanholder; Dominique D Benoit; Johan M A Decruyenaere; Francis A Colardyn Journal: J Am Soc Nephrol Date: 2003-04 Impact factor: 10.121
Authors: Edith M Simmons; Jonathan Himmelfarb; M Tugrul Sezer; Glenn M Chertow; Ravindra L Mehta; Emil P Paganini; Sharon Soroko; Stephanie Freedman; Karen Becker; Daniel Spratt; Yu Shyr; T Alp Ikizler Journal: Kidney Int Date: 2004-04 Impact factor: 10.612
Authors: Jonathan Himmelfarb; Ellen McMonagle; Stephanie Freedman; Jennifer Klenzak; Elizabeth McMenamin; Phuong Le; Lara B Pupim; T Alp Ikizler Journal: J Am Soc Nephrol Date: 2004-09 Impact factor: 10.121
Authors: L S Williams; J Rotich; R Qi; N Fineberg; A Espay; A Bruno; S E Fineberg; W R Tierney Journal: Neurology Date: 2002-07-09 Impact factor: 9.910
Authors: Ravindra L Mehta; Maria T Pascual; Sharon Soroko; Brandon R Savage; Jonathan Himmelfarb; T Alp Ikizler; Emil P Paganini; Glenn M Chertow Journal: Kidney Int Date: 2004-10 Impact factor: 10.612
Authors: Peter U Heuschmann; Peter L Kolominsky-Rabas; Bjoern Misselwitz; Peter Hermanek; Carsten Leffmann; R W C Janzen; Joachim Rother; Hans-Joachim Buecker-Nott; Klaus Berger Journal: Arch Intern Med Date: 2004-09-13
Authors: J Tyler Haller; Keaton Smetana; Michael J Erdman; Todd A Miano; Heidi M Riha; Alyssa Rinaldi; Nitin Goyal; G Morgan Jones Journal: Neurohospitalist Date: 2020-03-25