Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage

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Zheng , D , Sato , S , Arima , H , Heeley , E , Delcourt , C , Cao , Y , Chalmers , J , Anderson , C S , INTERACT2 Investigators , Scheperjans , F & Kaste , M 2016 , ' Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage ' , American Journal of Kidney Diseases , vol. 68 , no. 1 , pp. 94-102 . https://doi.org/10.1053/j.ajkd.2016.01.020

Title: Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage
Author: Zheng, Danni; Sato, Shoichiro; Arima, Hisatomi; Heeley, Emma; Delcourt, Candice; Cao, Yongjun; Chalmers, John; Anderson, Craig S.; INTERACT2 Investigators; Scheperjans, Filip; Kaste, Markku
Contributor: University of Helsinki, Neurologian yksikkö
University of Helsinki, Neurologian yksikkö
Date: 2016-07
Language: eng
Number of pages: 9
Belongs to series: American Journal of Kidney Diseases
ISSN: 0272-6386
URI: http://hdl.handle.net/10138/174899
Abstract: 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 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. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.
Subject: Kidney function
estimated glomerular filtration rate (eGFR)
chronic kidney disease (CKD)
dialysis
hemodialysis
stroke
intracerebral hemorrhage (ICH)
cerebral hemorrhage
cerebrovascular disease
systolic blood pressure
intensive blood pressure lowering treatment
INTERACT2
CHRONIC KIDNEY-DISEASE
GLOMERULAR-FILTRATION-RATE
STROKE PATIENTS
RESISTANT HYPERTENSION
RENAL-FUNCTION
WHITE-MATTER
LONG-TERM
OUTCOMES
ASSOCIATION
PREVALENCE
3124 Neurology and psychiatry
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