.jpg "Hannah Chan, PharmD, RPh photo")
Hannah Chan, PharmD, RPh
Emergency Medicine Clinical Pharmacist Specialist
Baptist Hospitals of Southeast Texas
Beaumont, Texas
Disclosure information not submitted.
Brian Gulbis, PharmD
Clinical Pharmacist Specialist
Memorial Hermann Texas Medical Center, United States
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Sean Savitz, MD
Vascular Neurology Physician
UT-HEALTH, United States
Disclosure information not submitted.
Christin Silos, MS
Research Assistant I
UT-HEALTH, United States
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Kristen Underbrink, PharmD
Pharmacy Resident
Memorial Hermann Texas Medical Center, United States
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Teresa Allison, BCCCP, BCPS, PharmD
Clinical Pharmacist Specialist
Memorial Hermann Texas Medical Center, United States
Disclosure information not submitted.
Title: Evaluating the Association Between Acute Kidney Injury and Outcomes in Intracerebral Hemorrhage
Introduction: Recent studies have proposed an association between chronic kidney disease (CKD) and small vessel brain disease (SVBD) due to similar regulation of the microvasculature of the kidney and brain. The impact of acute kidney injury (AKI) on short-term and long-term outcomes in patients with spontaneous intracerebral hemorrhage (ICH) are still unknown. The aim of this study was to analyze the outcomes associated with the development of AKI in patients with intracerebral hemorrhage.
Methods: A single center, retrospective cohort study evaluated adult patients who were hospitalized with spontaneous ICH between July 1, 2017 and July 1, 2020. Exclusion criteria included baseline CKD stage 4 or 5, hemodialysis, peritoneal dialysis, or death during hospitalization. The primary outcomes were incidence of AKI during hospitalization and persistence of renal dysfunction after discharge. AKI was defined by RIFLE criteria using serum creatinine.
Results: Of the 376 patients included, 78 (21%) developed AKI while hospitalized. Median (IQR) arrival systolic blood pressure (SBP) in the AKI group was 180 (147, 212) mmHg compared to 158 (139, 184) mmHg in the no-AKI group (p < 0.01). The median (IQR) change in SBP 12 hours after arrival was -38 (-71, -14) mmHg vs. -26 (-50, -3) mmHg (p = 0.01) with a percent change in 12 hour SBP of 23% vs. 15%, p = 0.02. Significance persisted at 18 and 24 hours after arrival. There was no difference between patients who had evidence of SVBD on imaging (55% vs 59%, p = 0.57), received contrast (78% vs. 75%, p = 0.50), experienced hypotension during admission (31% vs. 36%, p = 0.35), or were hypertensive on admission (82% vs. 73%, p = 0.11). Of those who developed AKI, 16 patients (21%) had kidney dysfunction after discharge. Of those, 3 (18%) were discharged requiring new scheduled hemodialysis, 7 (44%) experienced a 1.5x serum creatinine increase, 2 (13%) experienced a 2x serum creatinine increase and 4 (25%) experienced a 3x serum creatinine increase within 3 months of discharge.
Conclusion: AKI, which occurred in hospitalized ICH patients persisted in a large number of patients after discharge. Change in 12 hour SBP may play a significant role in determining which ICH patients are at higher risk of developing an AKI that may progress to chronic renal dysfunction.