Acute kidney injury tied to poorer stroke survival, subsequent CKD development

The presence of acute kidney injury (AKI) during stroke appears to contribute to increased mortality, with AKI tending to progress to chronic kidney disease (CKD) even without the need for renal replacement therapy, a study has found.

Researchers looked at 681 patients who had a stroke admitted to the rehabilitation facility in Changi General Hospital in Singapore. Of these patients, 443 had ischaemic strokes and 190 had haemorrhagic strokes.

Over a median follow-up of 141 months, 173 of the 617 patients (mean age 63.6 years) who met the selection criteria died. AKI was present in 75 (12.15 percent) patients during the index admission, and this condition had a detrimental effect on survival (hazard ratio [HR], 2.16, 95 percent confidence interval [CI], 1.49–3.13; p<0.001).

The following factors were also associated with heightened mortality: elevated blood urea (hazard ratio [HR], 3.02, 95 percent confidence interval [CI], 2.17–4.22; p<0.001) and creatinine (HR, 1.96, 95 percent CI, 1.50–2.57; p<0.001) during stroke affected survival adversely.

Of the 75 patients with AKI during the index admission for stroke, 49 (65 percent) were KDIGO grade 1 and 26 (35 percent) were KDIGO grade 2. None of them required renal replacement therapy. A total of 21 (28 percent) patients progressed to CKD over a median follow-up of 40.7 months.

The findings underscore the importance of having the renal function of patients with AKI monitored longitudinally for development of CKD.