• Adnan I Qureshi, Hunain Aslam, Werdah Zafar, Wei Huang, Iryna Lobanova, Syed H Naqvi, Kunal Malhotra, Niraj Arora, Premkumar N Chandrasekaran, Farhan Siddiq, Brandi R French, and Camilo R Gomez.
• Department of Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, MN.
• Crit. Care Med. 2020 Sep 1; 48 (9): 1334-1339.

ObjectivesAcute ischemic stroke patients are at risk of acute kidney injury due to volume depletion, contrast exposure, and preexisting comorbid diseases. We determined the occurrence rate and identified predictors associated with acute kidney injury in acute ischemic stroke patients.SettingMultiple specialized ICUs within academic medical centers.DesignPost hoc analysis of pooled data from prospective randomized clinical trials.PatientsAcute ischemic stroke patients recruited within 3 hours or within 5 hours of symptom onset.InterventionsIV recombinant tissue plasminogen activator, endovascular treatment, IV albumin, or placebo.Measurements And Main ResultsSerum creatinine levels from baseline and within day 5 or discharge were used to classify acute kidney injury classification into stages. Any increase in serum creatinine was seen in 697 (36.1%) and acute kidney injury was seen in 68 (3.5%) of 1,931 patients with acute ischemic stroke. Severity of acute kidney injury was grade I, II, and III in 3.1%, 0.4%, and 0.05% patients, respectively. Patients with albumin (5.5% compared with 2.6%; p = 0.001), preexisting hypertension (4.3% compared with 1.5%; p = 0.0041), and preexisting renal disease (9.1% compared with 3.0%; p < 0.0001) had higher risk of acute kidney injury. The risk of acute kidney injury was lower between those who either underwent CT angiography (2.0% compared with 4.7%; p = 0.0017) or endovascular treatment (1.6% compared with 4.2%; p = 0.0071). In the multivariate analysis, hypertension (odds ratio, 2.6; 95% CI, 1.2-5.6) and renal disease (odds ratio, 3.5; 95% CI, 1.9-6.5) were associated with acute kidney injury. The risk of death was significantly higher among patients with acute kidney injury (odds ratio, 2.7; 95% CI, 1.4-4.9) after adjusting for age and National Institutes of Health Stroke Scale score strata.ConclusionsThe occurrence rate of acute kidney injury in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of acute kidney injury increased the risk of death within 3 months among acute ischemic stroke patients.

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