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Acute kidney injury in patients with acute stroke

https://doi.org/10.24884/1561-6274-2014-18-2-50-68

Abstract

AIM. The aim of this study was to assess the incidence and severity of the acute kidney injury (AKI) in patients with stroke and investigate the relationship between AKI and in-hospital mortality. PATIENTS AND METHODS. 98 patients (54 (55%) men and 44 (45%) women, mean age was 63±11 years) with acute stroke were studied. Diagnosis was confirmed by tomography. 66 (67%) patients had ischemic stroke and 32 (33%) - hemorrhagic stroke . AKI was defined according to KDIGO Guidelines (2012). RESULTS. AKI was revealed in 30 patients (31%): 19 (20%) with first stage, 6 (6%) with stage 2 and 5 (5%) with stage 3. The incidence of AKI was significantly higher in patients with hemorrhagic stroke, than with ischemic stroke (50% and 21%, respectively, p=0,004). The AKI patients had a higher NIHSS (National Institutes of Health Stroke Scale) severity scores (p=0,001) and lower Rivermed mobility index (p=0,0007) compared with patients without AKI. Previous chronic heart failure was the independent predictor of AKI (relative risk 6.7, 95% confidence intervals 1.8 to 20.0). The in-hospital mortality rate was 18%. AKI was independent predictor of in-hospital mortality (relative risk 5.4, 95% confidence intervals 1.5 to 19.3). CONCLUSIONS. Our results show that the incidence of AKI in patients with acute stroke is 31%. The ischemic stroke patients had a twice higher rate of AKI compared with hemorrhagic stroke patients. Previous chronic heart failure was the predictor of AKI. AKI was significantly associated with in-hospital mortality.

About the Authors

M. V. Menzorov
Ульяновский государственный университет
Russian Federation


A. M. Shutov
Ульяновский государственный университет
Russian Federation


V. A. Lukyanova
ГУЗ «Центральная городская клиническая больница, г. Ульяновска»
Russian Federation


A. M. Gerdt
Ульяновский государственный университет
Russian Federation


I. Y. Grishenkin
Ульяновский государственный университет
Russian Federation


References

1. Кадыков АС, Шахпаронова НВ. Профилактика повторного ишемического инсульта. Consilium medicum Ukraina Неврология 2006; (8): 30-32

2. Суслина ЗА, Варакин ЮЯ. Эпидемиологические аспекты изучения инсульта. Время подводить итоги. Анналы клинической и экспериментальной неврологии 2007; (1): 22-28

3. Гусев ЕИ, Скворцова ВИ, Стаховская ЛВ. Эпидемиология инсульта в России. Журн неврол и психиатр (приложение «Инсульт») 2003; 8: 4-9

4. Пирадов МА, Гулевская ТС, Гнедовская ЕВ и др. Синдром полиорганной недостаточности при тяжелых формах инсульта (клинико-морфологическое исследование). Неврологический журнал 2006; 11(5): 9-13

5. Loh Y, McArthur DL, Vespa P et al. The risk of acute radiocontrast-mediated kidney injury following endovascular therapy for acute ischemic stroke is low. AJNR Am J Neuroradiol 2010; 31(9): 1584-1587

6. Khatri M, Himmelfarb J, Adams D et al. Acute Kidney Injury is Associated with Increased Hospital Mortality after Stroke. J Stroke Cerebrovasc Dis 2014; 23(1): 25-30

7. Cerda J, Lameire N, Eggers P et al. Epidemiology of Acute Kidney Injury. Clin J Am Soc Nephrol 2008; 3: 881-886

8. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Kidney International Supplements 2012; (2): 5-138

9. Bellomo R, Ronco C, Kellum JA et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8(4): R204-212

10. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2): R31

11. Bagshaw SM, George C, Bellomo R. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23(5): 1569-1574

12. Englberger L, Suri RM, Li Z et al. 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

13. Joannidis M, Metnitz B, Bauer P et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009; 35(10): 1692-1702

14. Covic A, Schiller A, Mardare NG et al. The impact of acute kidney injury on short-term survival in an Eastern European population with stroke. Nephrol Dial Transplant 2008; 23(7): 2228-2234

15. Chawla LS. Acute kidney injury leading to chronic kidney disease and long-term outcomes of acute kidney injury: the best opportunity to mitigate acute kidney injury? Contrib Nephrol 2011; 174: 182-190

16. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull WHO 1976; 54: 541-553

17. Collen, FM, Wade DT, Robb GF et al. The Rivermead mobility index: a further development of the Rivermead motor assessment. Disability & Rehabilitation 1991; 13(2): 50-54

18. Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol 1989; (46): 660-662

19. Hsu RK, McCulloch CE, Dudley RA et al. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol 2013; 24(1): 37-42

20. Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012; 81(9): 819-825

21. Ronco C, Haapio M, House AA et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 1527-1539

22. Vanmassenhove J, Vanholder R, Nagler E et al. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2013; 28(2): 254-273

23. Ostermann M, Chang RWS Challenges of defining acute kidney injury. Q J Med 2011; 104: 237-243

24. Joannidis M. Classification of acute kidney injury: are we there yet? Intensive Care Med 2007; 33: 572-574

25. Мензоров МВ, Шутов АМ, Серов ВА и др. Острое повреждение почек у больных инфарктом миокарда и эффективность тромболитической терапии. Кардиология 2012; 5: 8-12

26. Fliser D, Laville M, Covic A et al. European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO)clinical practice guidelines on acute kidney injury: part 1: definitions,conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012; 27(12): 4263-4272

27. Tsagalis G, Akrivos T, Alevizaki M et al. Long-term prognosis of acute kidney injury after first acute stroke. Clin J Am Soc Nephrol 2009; 4(3): 616-622

28. Мензоров МВ, Шутов АМ, Серов ВА и др. Острое повреждение почек у больных инфарктом миокарда с подъемом сегмента ST. Нефрология 2012; (1): 40-44

29. Шутов АМ, Курзина ЕВ, Серов ВА и др. Митральная регургитация у больных с хронической сердечной недостаточностью ассоциирована со снижением функционального состояния почек. Нефрология 2008; 12(1): 19-23

30. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930-936

31. Смирнов АВ, Каюков ИГ, Добронравов ВА, Кучер АГ. Острое повреждение почек и острая почечная недостаточность: некоторые уроки международных инициатив. Нефрология 2008;12 (3): 7-12

32. Macedo E, Bouchard J, Soroko SH et al. Fluid accumulation, recognition and staging of acute kidney injury in critically ill patients. Crit Care 2010; 14: R82

33. Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20: 672-679

34. Self WH, Barrett TW. Novel biomarkers: help or hindrance to patient care in the emergency department? Ann Emerg Med 2010; 56: 60-61

35. Shavit L, Dolgoker I, Ivgi H et al. Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery. Kidney Blood Press Res 2011; 34(2): 116-124


Review

For citations:


Menzorov M.V., Shutov A.M., Lukyanova V.A., Gerdt A.M., Grishenkin I.Y. Acute kidney injury in patients with acute stroke. Nephrology (Saint-Petersburg). 2014;18(2):55-60. (In Russ.) https://doi.org/10.24884/1561-6274-2014-18-2-50-68

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ISSN 1561-6274 (Print)
ISSN 2541-9439 (Online)