Acute Renal Failure Is Associated With Higher Death and Disability in Patients With Acute Ischemic Stroke: Analysis of Nationwide Inpatient Sample

• Published in: Stroke (1970) Vol. 45; no. 5; pp. 1478 - 1480
• Main Authors: Saeed, Fahad, Adil, Malik M, Khursheed, Faraz, Daimee, Usama A, Branch, Lionel A, Vidal, Gabriel A, Qureshi, Adnan I
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.05.2014; Lippincott Williams & Wilkins
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Aged; Aged, 80 and over; Biological and medical sciences; Brain Ischemia - complications; Brain Ischemia - epidemiology; Brain Ischemia - mortality; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - mortality; Disability Evaluation; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hospital Mortality; Humans; Inpatients - statistics & numerical data; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Nervous system (semeiology, syndromes); Neurology; Patient Discharge - statistics & numerical data; Patient Outcome Assessment; Renal Dialysis - statistics & numerical data; Renal failure; Stroke - complications; Stroke - epidemiology; Stroke - mortality; United States - epidemiology; Vascular diseases and vascular malformations of the nervous system; United States; Kidney disease; Human; Cerebral infarction; Stroke; Nervous system diseases; Urinary system disease; Cardiovascular disease; Acute renal failure; Cerebral disorder; Vascular disease; Disability; acute ischemic stroke; Central nervous system disease; Brain ischemia; Cerebrovascular disease; acute renal failure
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.114.004672

BACKGROUND AND PURPOSE—Acute renal failure (ARF) in setting of acute ischemic stroke (AIS) is associated with worse outcome. We sought to determine the prevalence of ARF and effect on outcomes of patients with AIS. METHODS—Data from all patients admitted to US hospitals between 2002 and 2010 with a primary discharge diagnosis of ischemic stroke and secondary diagnosis of ARF were included. The effect of ARF on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. RESULTS—Of 7 068 334 patients with AIS, 372 223 (5.3%) had ARF during hospitalization. Dialysis was required in 2364 (0.6%) of 372 223 patients. Patients with AIS with ARF had higher rates of moderate to severe disability (41.3% versus 30%; P<0.0001), intracerebral hemorrhage (1.0% versus 0.5%; P<0.0001), and in-hospital mortality (8.4% versus 2.9%; P<0.0001) compared with those without ARF. After adjusting for confounding factors, patients with AIS with ARF had higher odds of moderate to severe disability (odds ratio, 1.3; 95% confidence interval, 1.3–1.4; P<0.0001), intracerebral hemorrhage (odds ratio, 1.4; 95% confidence interval, 1.3–1.6; P<0.0001), and death (odds ratio, 2.2; 95% confidence interval, 2.0–2.2; P<0.0001). CONCLUSIONS—ARF in patients with AIS is associated with significantly higher rates of moderate to severe disability at discharge and in-hospital mortality.