Alireza Shirazian1, Andres F Peralta-Cuervo2, Maria P Aguilera-Pena2, Louis Cannizzaro3, Vi Tran4, Doan Nguyen5, Ifeanyi Iwuchukwu6. 1. Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA. ashirazian@tulane.edu. 2. Ochsner Clinical School, Jefferson, LA, USA. 3. Ochsner Clinic Foundation, Jefferson, LA, USA. 4. University of South Alabama School of Medicine, Mobile, AL, USA. 5. Institute for Translational Research, Ochsner Medical Center, Jefferson, LA, USA. 6. Ochsner Clinical School, The University of Queensland, Jefferson, LA, USA.
Abstract
BACKGROUND/ OBJECTIVES: We postulated that renal replacement therapy (RRT) in ICH patients with advanced chronic kidney disease (CKD) is associated with increased frequency and size of perihematomal edema (PHE) expansion and worse patient outcomes. METHODS: The Get With the Guidelines-Stroke Registry was queried for all patients admitted with ICH (N = 1089). Secondary causes, brainstem ICH, and initial HV < 7 cc were excluded. We identified patients with advanced CKD with and without RRT following admission for ICH. ABC/2 formula was used to measure hematoma volume (HV) and PHE. Patient outcomes were 30-day mortality, 90-day modified Rankin Scale score, and discharge disposition. We used propensity scores and optimal matching to adjust for multiple covariates. RESULTS: At 48 h post-ICH, PHE expansion was a significant predictor of poor patient outcomes in our cohort. Patients with CKD who received sustained low-efficacy dialysis (SLED) treatment had larger 48 h PHE growth compared to both untreated CKD group (average treatment effect (ATE), 11.5; 95% CI, 4.9-18.1; p < 0.01) and all untreated patients (ATE, 7.43; 95% CI, 4.7-10.2; p < 0.01). Moreover, patients with RRT had significantly worse functional and mortality outcomes. CONCLUSIONS: SLED treatment in ICH patients with CKD was associated with significant increase in rate and frequency of PHE expansion. Absolute increase in PHE during 48-h post-ICH was associated with increased mortality and worse functional outcomes. Further prospective and multicenter evaluation is needed to differentiate the effects of RRT on hematoma dynamics and patient outcomes from those attributed to CKD.
BACKGROUND/ OBJECTIVES: We postulated that renal replacement therapy (RRT) in ICH patients with advanced chronic kidney disease (CKD) is associated with increased frequency and size of perihematomal edema (PHE) expansion and worse patient outcomes. METHODS: The Get With the Guidelines-Stroke Registry was queried for all patients admitted with ICH (N = 1089). Secondary causes, brainstem ICH, and initial HV < 7 cc were excluded. We identified patients with advanced CKD with and without RRT following admission for ICH. ABC/2 formula was used to measure hematoma volume (HV) and PHE. Patient outcomes were 30-day mortality, 90-day modified Rankin Scale score, and discharge disposition. We used propensity scores and optimal matching to adjust for multiple covariates. RESULTS: At 48 h post-ICH, PHE expansion was a significant predictor of poor patient outcomes in our cohort. Patients with CKD who received sustained low-efficacy dialysis (SLED) treatment had larger 48 h PHE growth compared to both untreated CKD group (average treatment effect (ATE), 11.5; 95% CI, 4.9-18.1; p < 0.01) and all untreated patients (ATE, 7.43; 95% CI, 4.7-10.2; p < 0.01). Moreover, patients with RRT had significantly worse functional and mortality outcomes. CONCLUSIONS: SLED treatment in ICH patients with CKD was associated with significant increase in rate and frequency of PHE expansion. Absolute increase in PHE during 48-h post-ICH was associated with increased mortality and worse functional outcomes. Further prospective and multicenter evaluation is needed to differentiate the effects of RRT on hematoma dynamics and patient outcomes from those attributed to CKD.
Authors: Thomas J Hoerger; Sean A Simpson; Benjamin O Yarnoff; Meda E Pavkov; Nilka Ríos Burrows; Sharon H Saydah; Desmond E Williams; Xiaohui Zhuo Journal: Am J Kidney Dis Date: 2014-11-05 Impact factor: 8.860
Authors: Amber O Molnar; Sarah E Bota; Amit X Garg; Ziv Harel; Ngan Lam; Eric McArthur; Gihad Nesrallah; Jeffrey Perl; Manish M Sood Journal: J Am Soc Nephrol Date: 2016-01-28 Impact factor: 10.121