Estimated GFR and the effect of intensive blood pressure lowering after acute intracerebral hemorrhage

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dc.contributor.authorZheng, Danni
dc.contributor.authorSato, Shoichiro
dc.contributor.authorArima, Hisatomi
dc.contributor.authorHeeley, Emma
dc.contributor.authorDelcourt, Candice
dc.contributor.authorCao, Yongjun
dc.contributor.authorChalmers, John
dc.contributor.authorAnderson, Craig
dc.date.accessioned2017-08-17T13:11:38Z
dc.date.available2017-08-17T13:11:38Z
dc.date.issued2016
dc.description.abstractBACKGROUND: 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<140mmHg) or contemporaneous guideline-based (target SBP<180mmHg) 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 <60mL/min/1.73m(2), 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.
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dc.identifier.citationZheng D, Sato S, Arima H, Heeley E, Delcourt C, Cao Y, Chalmers J, Anderson CS; INTERACT2 Investigators. Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage. Am J Kidney Dis. 2016 Jul;68(1):94-102
dc.identifier.urihttp://hdl.handle.net/11447/1590
dc.identifier.urihttp://doi.org/10.1053/j.ajkd.2016.01.020
dc.language.isoen_US
dc.publisherElsevier
dc.subjectINTERACT2
dc.subjectKidney function
dc.subjectcerebral hemorrhage
dc.subjectcerebrovascular disease
dc.subjectchronic kidney disease (CKD)
dc.subjectdialysis
dc.subjectestimated glomerular filtration rate (eGFR)
dc.subjecthemodialysis
dc.subjectintensive blood pressure lowering treatment
dc.subjectintracerebral hemorrhage (ICH)
dc.subjectstroke
dc.subjectsystolic blood pressure
dc.titleEstimated GFR and the effect of intensive blood pressure lowering after acute intracerebral hemorrhage
dc.typeArtículo

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