Acute kidney injury after aneurysmal subarachnoid hemorrhage and its effect on patient outcome: an exploratory analysis

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  • 1 Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary;
  • 2 Department of Internal Medicine, University of Calgary, Alberta;
  • 3 Division of Neurosurgery, University of British Columbia, Vancouver;
  • 5 Division of Neurosurgery and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto;
  • 6 Institute of Medical Science, University of Toronto, Ontario, Canada; and
  • 4 University at Buffalo Neurosurgery, Buffalo, New York
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OBJECTIVE

Acute kidney injury (AKI) is associated with death in critically ill patients, but this complication has not been well characterized after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of this study was to determine the incidence of AKI after aSAH and to identify risk factors for renal dysfunction. Secondary objectives were to examine what effect AKI has on patient mortality and functional outcome at 12 weeks post-aSAH.

METHODS

The authors performed a post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial data set (clinical trial registration no.: NCT00111085, https://clinicaltrials.gov). The primary outcome of interest was the development of AKI, which was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes of interest were death and a modified Rankin Scale score greater than 2 at 12 weeks post-aSAH. Propensity score matching was used to assess for a significant treatment effect related to clazosentan administration and AKI. Univariate analysis, locally weighted scatterplot smoothing (LOWESS) curves, and stepwise logistic regression models were used to evaluate for associations between baseline or disease-related characteristics and study outcomes.

RESULTS

One hundred fifty-six (38%) of the 413 patients enrolled in the CONSCIOUS-1 trial developed AKI during their ICU stay. A history of hypertension (p < 0.001) and the number of nephrotoxic medications administered (p = 0.029) were independent predictors of AKI on multivariate analysis. AKI was an independent predictor of death (p = 0.028) but not a poor functional outcome (p = 0.21) on multivariate testing. Unresolved renal dysfunction was the strongest independent predictor of death in this cohort (p < 0.001).

CONCLUSIONS

AKI is a common complication following aSAH. Patients with premorbid hypertension and those treated with nephrotoxic medications may be at greater risk for renal dysfunction. AKI appears to confer an increased probability of death after aSAH.

ABBREVIATIONS AKI = acute kidney injury; AKIN = Acute Kidney Injury Network; AOCKI = acute on chronic kidney injury; aSAH = aneurysmal subarachnoid hemorrhage; CCI = Charlson Comorbidity Index; CKD = chronic kidney disease; DIND = delayed ischemic neurological deficit; eGFR = estimated glomerular filtration rate; KDIGO = Kidney Disease: Improving Global Outcomes; LOWESS = locally weighted scatterplot smoothing; RIFLE = Risk, Injury, Failure, Loss, and End-stage kidney disease; WFNS = World Federation of Neurosurgical Societies.

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Contributor Notes

Correspondence Matthew E. Eagles: University of Calgary, AB, Canada. matthew.eagles@ucalgary.ca.

INCLUDE WHEN CITING Published online July 12, 2019; DOI: 10.3171/2019.4.JNS19103.

Disclosures Dr. Macdonald reports ownership of Edge Therapeutics, Inc. and receiving non–study-related clinical or research effort support from the following organizations: Brain Aneurysm Foundation, Heart and Stroke Foundation of Canada, Canadian Institutes for Health Research, and Physicians Services Incorporated Foundation.

  • 1

    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P: Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204R212, 2004

    • Search Google Scholar
    • Export Citation
  • 2

    Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373383, 1987

    • Search Google Scholar
    • Export Citation
  • 3

    Chavakula V, Gross BA, Frerichs KU, Du R: Contrast-induced nephropathy in patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care 19:157160, 2013

    • Search Google Scholar
    • Export Citation
  • 4

    Chen S, Li Q, Wu H, Krafft PR, Wang Z, Zhang JH: The harmful effects of subarachnoid hemorrhage on extracerebral organs. Biomed Res Int 2014:858496, 2014

    • Search Google Scholar
    • Export Citation
  • 5

    Eagles ME, Tso MK, Macdonald RL: Significance of fluctuations in serum sodium levels following aneurysmal subarachnoid hemorrhage: an exploratory analysis. J Neurosurg [epub ahead of print August 1, 2018. DOI: 10.3171/2018.3.JNS173068]

    • Search Google Scholar
    • Export Citation
  • 6

    Frontera JA, Fernandez A, Schmidt JM, Claassen J, Wartenberg KE, Badjatia N, : Impact of nosocomial infectious complications after subarachnoid hemorrhage. Neurosurgery 62:8087, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Hop JW, Rinkel GJ, Algra A, van Gijn J: Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 28:660664, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, : Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 41:14111423, 2015

    • Search Google Scholar
    • Export Citation
  • 9

    James MT, Grams ME, Woodward M, Elley CR, Green JA, Wheeler DC, : A meta-analysis of the association of estimated GFR, albuminuria, diabetes mellitus, and hypertension with acute kidney injury. Am J Kidney Dis 66:602612, 2015

    • Search Google Scholar
    • Export Citation
  • 10

    Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:1836, 1990

    • Search Google Scholar
    • Export Citation
  • 11

    Kellum JA, Bellomo R, Ronco C: Definition and classification of acute kidney injury. Nephron Clin Pract 109:c182c187, 2008

  • 12

    Kellum JA, Lameire N: Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 17:204, 2013

  • 13

    Lawton MT, Vates GE: Subarachnoid hemorrhage. N Engl J Med 377:257266, 2017

  • 14

    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461470, 1999

    • Search Google Scholar
    • Export Citation
  • 15

    Libório AB, Leite TT, Neves FM, Teles F, Bezerra CT: AKI complications in critically ill patients: association with mortality rates and RRT. Clin J Am Soc Nephrol 10:2128, 2015

    • Search Google Scholar
    • Export Citation
  • 16

    Lovelock CE, Rinkel GJ, Rothwell PM: Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology 74:14941501, 2010

    • Search Google Scholar
    • Export Citation
  • 17

    Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X: A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care 18:R144, 2014

    • Search Google Scholar
    • Export Citation
  • 18

    Macdonald RL, Kassell NF, Mayer S, Ruefenacht D, Schmiedek P, Weidauer S, : Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke 39:30153021, 2008

    • Search Google Scholar
    • Export Citation
  • 19

    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, : Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, : KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 61:649672, 2013

    • Search Google Scholar
    • Export Citation
  • 21

    Pazhayattil GS, Shirali AC: Drug-induced impairment of renal function. Int J Nephrol Renovasc Dis 7:457468, 2014

  • 22

    Ray B, Rickert KL, Welch BG, White JA, Klinger DR, Boudreaux BP, : Development of contrast-induced nephropathy in subarachnoid hemorrhage: a single center perspective. Neurocrit Care 19:150156, 2013

    • Search Google Scholar
    • Export Citation
  • 23

    Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL: Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 38:23152321, 2007

    • Search Google Scholar
    • Export Citation
  • 24

    Solenski NJ, Haley EC Jr, Kassell NF, Kongable G, Germanson T, Truskowski L, : Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med 23:10071017, 1995

    • Search Google Scholar
    • Export Citation
  • 25

    Tujjar O, Belloni I, Hougardy JM, Scolletta S, Vincent JL, Creteur J, : Acute kidney injury after subarachnoid hemorrhage. J Neurosurg Anesthesiol 29:140149, 2017

    • Search Google Scholar
    • Export Citation
  • 26

    Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, : Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813818, 2005

    • Search Google Scholar
    • Export Citation
  • 27

    Wartenberg KE, Schmidt JM, Claassen J, Temes RE, Frontera JA, Ostapkovich N, : Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 34:617624, 2006

    • Search Google Scholar
    • Export Citation
  • 28

    Zacharia BE, Ducruet AF, Hickman ZL, Grobelny BT, Fernandez L, Schmidt JM, : Renal dysfunction as an independent predictor of outcome after aneurysmal subarachnoid hemorrhage: a single-center cohort study. Stroke 40:23752381, 2009

    • Search Google Scholar
    • Export Citation

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