Acute kidney injury in patients with spontaneous intracerebral hemorrhage - Is it a real problem?

Acute kidney injury (AKI) is common in critically ill intensive care unit patients, including those with intracerebral hemorrhage (ICH). Spontaneous ICH (sICH) accounts for 10-15% of all strokes and is a significant cause of death and disability in people over 40 years of age worldwide, and the development of AKI in these patients might further worsen their outcomes. The aim of the study was to determine the incidence and risk factors for AKI, as well as short-term outcomes in patients with sICH.

In this single-center study, we retrospectively analyzed the data of consecutive patients diagnosed with sICH.

Of the 237 patients with sICH included in the study, 13.5% developed AKI. Risk factors for AKI were as follows: severity of neurological deficit as measured by the National Institutes of Health Stroke Scale (NIHSS), larger hematoma volume, as well as higher baseline mean systolic and diastolic blood pressure. Furthermore, patients who developed AKI had higher levels of serum glucose, urea, and serum creatinine and lower estimated glomerular filtration rate (eGFR) on hospital admission. In addition, the overall and in-hospital mortality were much higher in patients with AKI than in those without AKI. Finally, adjusted regression analysis identified the in-hospital use of nephrotoxic antibiotics as a major risk factor, increasing the likelihood of AKI eightfold.

These findings highlight the importance of early identification of high-risk patients and careful management of nephrotoxic agents to reduce the incidence and adverse outcomes of AKI in ICH patients.