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Under-recognized post-stroke acute kidney injury: risk factors and relevance for stroke outcome of a frequent comorbidity

  • Nephrology - Original Paper
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Abstract

Background

Acute kidney injury (AKI) is emerging as a predictor of poor stroke outcome, however, it is often not recognized. The aim of our study was to evaluate post-stroke AKI burden, AKI risk factors and their influence in post-stroke outcome.

Methods

From 2013 to 2016, 440 individuals with stroke diagnosis admitted in Stroke Unit, Foundation IRCCS Policlinico San Matteo (Pavia, Italy), were retrospectively enrolled. AKI cases identified by KDIGO criteria through the electronic database and hospital chart review were compared with the ones reported in discharge letters or in administrative hospital data base. Mortality data were provided by Agenzia Tutela della Salute of Pavia.

Results

We included 430 patients in the analysis. Median follow-up was 19.2 months. We identified 79 AKI cases (18% of the enrolled patients, 92% classified as AKI stage 1), a fivefold higher number of cases than the ones reported at discharge. 37 patients had AKI at the admission in the hospital, while 42 developed AKI during the hospitalization. Cardioembolic (p = 0.01) and hemorrhagic (p = 0.01) stroke types were associated with higher AKI risk. Admission National Institutes of Health Stroke Scale (NIHSS, p < 0.05) and Charlson Comorbidity Index (p < 0.01) were independently associated with overall AKI, while admission NIHSS (p < 0.05) and eGFR (p < 0.005) were independently associated with AKI developed during the hospitalization. AKI was associated to longer in-hospital stay (p = 0.01), worse Rankin Neurologic Disability Score at discharge (p < 0.0001) and discharge disposition other than home (p = 0.03). AKI was also independently associated to higher in-hospital mortality (OR 3.9 95% CI 1.2–12.9 p = 0.023) but not with long-term survival.

Conclusions

Post-stroke AKI diagnosis needs to be improved by strictly monitoring individuals with cardioembolic or hemorrhagic stroke, reduced kidney function, higher Charlson Comorbidity Index and worse NIHSS at presentation.

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Authors and Affiliations

  1. Unit of Nephrology, Dialysis, Transplantation, Foundation I.R.C.C.S. Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy

    Fabrizio Grosjean, Rosario Maccarrone & Teresa Rampino

  2. Unit of Cardiac and Cerebrovascular Disease-General Medicine 2, Foundation I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy

    Michela Tonani & Alessandra Martignoni

  3. Unit of Informative System and Management Control, ASST of Pavia, Pavia, Italy

    Carlo Cerra & Simona Migliazza

  4. School of Medicine, University of Pavia, Pavia, Italy

    Federica Spaltini

  5. Service of Clinical Epidemiology and Biometry, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

    Annalisa De Silvestri & Carmine Tinelli

  6. General Medicine 2, Foundation I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy

    Francesco Falaschi & Antonio Di Sabatino

Authors
  1. Fabrizio Grosjean
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  2. Michela Tonani
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Corresponding author

Correspondence to Fabrizio Grosjean.

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The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was approved by our Institutional Ethic Committee (protocol number 5344/2016) and all the procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Grosjean, F., Tonani, M., Maccarrone, R. et al. Under-recognized post-stroke acute kidney injury: risk factors and relevance for stroke outcome of a frequent comorbidity. Int Urol Nephrol 51, 1597–1604 (2019). https://doi.org/10.1007/s11255-019-02203-4

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