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Epidemiology of acute kidney injury in patients with stroke: a retrospective analysis from the neurology ICU

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Abstract

Acute kidney injury (AKI) is proven to be an independent risk factor for adverse clinical outcomes in patients with stroke, but data about the epidemiology of AKI in these patients are not well characterized. Therefore, we investigated the incidence, risk factors, and the impact of AKI on the clinical outcomes in a group of Chinese patients with stroke. We retrospectively recruited 647 stroke patients from the neurology ICU between 2012 and 2013. AKI was identified according to the 2012 KDIGO criteria. Baseline estimated glomerular filtration rate (eGFR) was calculated using modified Chronic Kidney Disease Epidemiology Collaboration equation for Chinese patients. National Institutes of Health Stroke Scale (NIHSS) score was assessed for the stroke severity. A total of 135 (20.9%) patients developed AKI. Patients with AKI stages from 1 to 3 were 84 (62.2%), 26 (19.3%), and 25 (18.5%), respectively. Logistic regression analysis showed that independent risk factors for AKI were higher NIHSS score (OR, 1.027; 95% CI 1.003–1.051), lower baseline eGFR (OR, 0.985; 95% CI 0.977–0.993), the presence of hypertension (OR, 1.592; 95% CI 1.003–2.529), and infectious complications (OR, 3.387; 95% CI 1.997–5.803) (P < 0.05 for all). AKI patients were also significantly associated with all-cause mortality in the neurology ICU [OR and 95% CI of AKI-stage 1, AKI-stage 2, and AKI-stage 3 were 4.961 (2.191–11.232), 19.722 (6.354–61.217), and 48.625 (17.616–134.222), respectively (P < 0.001 for all)]. AKI is common among patients with stroke and is associated with worse clinical outcomes after stroke. Prevention of AKI seems to be very important among these patients, because they are exposed to many risk factors for developing AKI.

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Abbreviations

AKI:

Acute kidney injury

KDIGO:

Kidney Disease: Improving Global Outcomes

NICU:

Neurological intensive care unit

Scr:

Serum creatinine

eGFR:

Estimated glomerular filtration rate

BMI:

Body mass index

MAP:

Mean arterial blood pressure

NIHSS:

National Institutes of Health Stroke Scale

mRS:

Modified Rankin Scale

ACEIs:

Angiotensin-converting enzyme inhibitors

ARBs:

Angiotensin receptor blockers

NSAIDs:

Non-steroidal anti-inflammatory drugs

WBC:

White blood cell count

PLT:

Platelet

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CO2CP:

Carbon dioxide combining power

BUN:

Blood urea nitrogen

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

OR:

Odds ratios

CI:

Confidence intervals

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Author notes

  1. Dongxue Wang and Yidan Guo contributed equally.

Authors and Affiliations

  1. Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Dongxue Wang & Yin Zhang

  2. Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No 10, Tieyi Road, Beijing, People’s Republic of China

    Yidan Guo & Yang Luo

  3. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Zhaoxia Li

  4. Department of Intensive Care Unit, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    Ang Li

Authors
  1. Dongxue Wang
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  2. Yidan Guo
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  3. Yin Zhang
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  4. Zhaoxia Li
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  5. Ang Li
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  6. Yang Luo
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Corresponding author

Correspondence to Yang Luo.

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Conflict of interest

The authors declare that they have no competing interests.

Statement of human and animal rights

The study was approved by the Ethics Committee of the Beijing Tiantan Hospital.

Informed consent

The exemption of the informed consent in our study was also given by the ethical committee in the hospital because our study was a retrospective study and no any other intervence was performed towards the patients in our study.

Sources of funding

This study was supported by the Foundation of Clinical Characteristics of the Capital Project from Beijing Municipal Commission of Science and Technology (Grant Number Z141107002514150).

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Wang, D., Guo, Y., Zhang, Y. et al. Epidemiology of acute kidney injury in patients with stroke: a retrospective analysis from the neurology ICU. Intern Emerg Med 13, 17–25 (2018). https://doi.org/10.1007/s11739-017-1703-z

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  • DOI: https://doi.org/10.1007/s11739-017-1703-z

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