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Lookup NU author(s): Professor Christopher PriceORCiD, Dr Stuart Huntley, Dr Rachel Lakey
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© 2016 The Authors. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-based (target SBP < 180 mm Hg) BP management. Setting & Participants: 2,823 patients from 144 clinical hospitals in 21 countries. Predictors Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (>90, 60-90, and <60 mL/min/1.73 m2, respectively). Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs.
Author(s): Zheng D, Sato S, Arima H, Heeley E, Delcourt C, Cao Y, Chalmers J, Anderson CS, Davis S, Huang Y, Lavados P, Neal B, Parsons MW, Lindley R, Morgenstern L, Robinson T, Stapf C, Tzourio C, Wang JG, Huang Y, Chen S, Chen XY, Cui L, Liu Z, Lu C, Wang J, Wu S, Xu E, Yang Q, Zhang C, Zhang J, Beer R, Schmutzhard E, Redondo P, Kaste M, Soinne L, Tatlisumak T, Stapf C, Wartenberg K, Ricci S, Klijn K, Azevedo E, Chamorro A, Arnold M, Fischer U, Kaul S, Pandian J, Boyini H, Singh S, Rabinstein AA, Estol C, Silva G, Lavados P, Olavarria VV, Robinson TG, Simes RJ, Bousser M-G, Hankey G, Jamrozik K, Johnston SC, Li S, Bailey K, Cheung T, Chintapatla S, Ducasse E, Erho T, Hata J, Holder B, Knight E, Lindley R, Leroux M, Sasse T, Odgers E, Walsh R, Wolfowicz Z, Chen G, Fuentes S, Lindley R, Peng B, Schneble H-M, Wang M-X, Billot L, Heritier S, Li Q, Woodward M, Abimbola S, Anderson S, Chan E, Cheng G, Chmielnik P, Hata J, Leighton S, Liu J-Y, Rasmussen B, Saxena A, Tripathy S, Armenis M, Baig MA, Naidu B, Starzec G, Steley S, Knight E, Bailey K, Cheung T, Odgers E, Ducasse E, Holder B, Wolfowicz Z, Walsh R, Chintapatla S, Erho T, Estol C, Moles A, Ruiz A, Zimmermann M, Marinho J, Alves S, Angelim R, Araujo J, Kawakami L, Lavados P, Olavarria VV, Bustos C, Gonzalez F, Munoz Venturelli P, Huang Y, Chen X, Huang Y, Jia R, Li N, Qu S, Shu Y, Song A, Sun J, Xiao J, Zhao Y, Wang JG, Huang Q, Stapf C, Vicaut E, Chamam A, Viaud M-C, Dert C, Fiedler U, Jovis V, Kabla S, Marchand S, Pena A, Rochaud V, Mallikarjuna K, Boyini H, Hasan N, Berge E, Sandset EC, Forarsveen AS, Robinson T, Richardson D, Kumar T, Lewin S, Poulter N, Field J, Anjum A, Wilson A, Perelmuter H, Agarie AM, Barboza AG, Recchia LA, Miranda IF, Rauek SG, Duplessis RJ, Dewey H, Walker L, Petrolo S, Bladin C, Sturm J, Crimmins D, Griffiths D, Schutz A, Zenteno V, Parsons MW, Miteff F, Spratt N, Kerr E, Levi CR, Phan TG, Ma H, Sanders L, Moran C, Wong K, Read S, Henderson R, Wong A, Hull R, Skinner G, Davis S, 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Publication type: Article
Publication status: Published
Journal: American Journal of Kidney Diseases
Year: 2016
Volume: 68
Issue: 1
Pages: 94-102
Print publication date: 01/07/2016
Online publication date: 03/03/2016
Acceptance date: 17/01/2016
ISSN (print): 0272-6386
ISSN (electronic): 1523-6838
Publisher: W.B. Saunders
URL: http://doi.org/10.1053/j.ajkd.2016.01.020
DOI: 10.1053/j.ajkd.2016.01.020
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