Skip to main content

Advertisement

SpringerLink
Log in

Effect of Race–Ethnicity and CT Angiography on Renal Injury During Blood Pressure Treatment for Intracerebral Hemorrhage

  • Original work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Lowering blood pressure intensively in acute intracerebral hemorrhage (ICH) is associated with adverse renal events; Blacks and Hispanics have a higher incidence of ICH and kidney disease than Whites. In addition, CT angiography (CTA), which may also be associated with acute kidney injury (AKI), is often done in acute ICH. Our objective was to investigate the relationship between aggressive BP management, CTA, race–ethnicity and the risk of developing AKI in patients presenting with ICH.

Methods

We retrospectively calculated the difference between the highest and lowest systolic blood pressure during the first 24 h of admission in patients with spontaneous ICH over 30 months. Creatinine (Cr) levels at admission were compared to the highest Cr level during the first 7 days after admission. AKI was defined as any > 50% increase of baseline Cr during the first 7 days. Logistic regression models were used to assess the association between race–ethnicity and CTA and AKI. We also analyzed the incidence of AKI stratified by race–ethnicity.

Results

A total of 394 patients were included (mean age ± SD 63 ± 14 years), 160 patients (41%) were women, 162 (41%) Hispanic, 39 (10%) White and 189 (48%) Black. Most of the patients underwent CTA (73%). The prevalence of AKI was (18%), but no difference was found in AKI incidence (19% in Blacks vs. 17% in Whites vs. 18% in Hispanics (p = 0.940). In fully adjusted models, AKI was not associated with race–ethnicity (p = 0.665) or CTA (p = 0.187). The stratified analysis by race–ethnicity did not change our findings.

Conclusion

We found no association between race–ethnicity or CTA and AKI during the acute management of ICH in a real-life stroke population. Our findings suggest that CTA can be safely obtained in acute ICH, even in populations of diverse race–ethnicity who may be more prone to adverse kidney events. CTA did not contribute to developing AKI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hewgley H, Turner SC, Vandigo JE, Marler J, Snyder H, Chang JJ, et al. Impact of admission hypertension on rates of acute kidney injury in intracerebral hemorrhage treated with intensive blood pressure control. Neurocrit Care. 2018;28:344–52.

    Article  Google Scholar 

  2. Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–43.

    Article  Google Scholar 

  3. Grams ME, Matsushita K, Sang Y, Estrella MM, Foster MC, Tin A, et al. Explaining the racial difference in aki incidence. J Am Soc Nephrol. 2014;25:1834–41.

    Article  Google Scholar 

  4. Leasure AC, King ZA, Torres-Lopez V, Murthy SB, Kamel H, Shoamanesh A, et al. Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence. Neurology. 2020;94:e314–22.

    Article  Google Scholar 

  5. Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, et al. Status of cardiovascular disease and stroke in hispanics/latinos in the united states: a science advisory from the american heart association. Circulation. 2014;130:593–625.

    Article  Google Scholar 

  6. Labovitz DL, Halim A, Boden-Albala B, Hauser WA, Sacco RL. The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and hispanics. Neurology. 2005;65:518–22.

    Article  CAS  Google Scholar 

  7. Koch S, Elkind MS, Testai FD, Brown WM, Martini S, Sheth KN, et al. Racial-ethnic disparities in acute blood pressure after intracerebral hemorrhage. Neurology. 2016;87:786–91.

    Article  Google Scholar 

  8. McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K. Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med. 2017;43:774–84.

    Article  Google Scholar 

  9. McDonald RJ, McDonald JS, Newhouse JH, Davenport MS. Controversies in contrast material-induced acute kidney injury: closing in on the truth? Radiology. 2015;277:627–32.

    Article  Google Scholar 

  10. Brinjikji W, Demchuk AM, Murad MH, Rabinstein AA, McDonald RJ, McDonald JS, et al. Neurons over nephrons: systematic review and meta-analysis of contrast-induced nephropathy in patients with acute stroke. Stroke. 2017;48:1862–8.

    Article  Google Scholar 

  11. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2015;46:2032–60.

    Article  Google Scholar 

  12. Khwaja A. Kdigo clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179-184.

    Google Scholar 

  13. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, et al. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem. 2007;53:766–72.

    Article  CAS  Google Scholar 

  14. Burgess LG, Goyal N, Jones GM, Khorchid Y, Kerro A, Chapple K, et al. Evaluation of acute kidney injury and mortality after intensive blood pressure control in patients with intracerebral hemorrhage. J Am Heart Assoc. 2018;7

  15. Wang R, Hu H, Hu S, He H, Shui H. Beta2-microglobulin is an independent indicator of acute kidney injury and outcomes in patients with intracerebral hemorrhage. Medicine (Baltimore). 2020;99:e19212.

    Article  CAS  Google Scholar 

  16. Lopes JA, Jorge S. The rifle and akin classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J. 2013;6:8–14.

    Article  Google Scholar 

Download references

Acknowledgments

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1365, Miami, FL, 33136, USA

    Nayna Shah, Sebastian Koch, Zakariya Hassouneh, Antonio Bustillo, Marialaura Simonetto, Kristine O’Phelan & Emma Boslet

Authors
  1. Nayna Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zakariya Hassouneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Bustillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marialaura Simonetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kristine O’Phelan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emma Boslet
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SK, KP contributed to study conception and design. NS, EB, ZH, SK contributed to study data collection. AB, MS, SK contributed to study data aalysis and statistics. SK, KP, NS, AB, MS contributed to study finding interpretation. SK, NS, AB, ZH, KP, MS, EB manuscript writing, review and submission and approved the final manuscript.

Corresponding author

Correspondence to Sebastian Koch.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, N., Koch, S., Hassouneh, Z. et al. Effect of Race–Ethnicity and CT Angiography on Renal Injury During Blood Pressure Treatment for Intracerebral Hemorrhage. Neurocrit Care 35, 687–692 (2021). https://doi.org/10.1007/s12028-021-01206-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-021-01206-3

Keywords

Search

Navigation