Incidence and impact on outcomes of acute kidney injury after a stroke: a systematic review and meta-analysis.

Arnold, Julia and Ng, Khai Ping and Sims, Don and Gill, Paramjit and Cockwell, Paul and Ferro, Charles (2018) Incidence and impact on outcomes of acute kidney injury after a stroke: a systematic review and meta-analysis. BMC nephrology, 19 (1). p. 283. ISSN 1471-2369. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

BACKGROUND

Patients with chronic kidney disease have worse outcomes after stroke. However, the burden of acute kidney injury after stroke has not been extensively investigated.

METHODS

We used MEDLINE and Embase to conduct a systematic review and meta-analysis of published studies that provided data on the risk of AKI and outcomes in adults after ischemic and hemorrhagic stroke. Pooled incidence was examined using the Stuart-Ord method in a DerSimonian-Laird model. Pooled Odds Ratios and 95% confidence intervals were calculated for outcomes using a random effects model. This review was registered with PROSPERO (CRD42017064588).

RESULTS

Eight studies were included, five from the United States, representing 99.9% of included patients. Three studies used established acute kidney injury criteria based on creatinine values to define acute kidney injury and five used International Classification of Diseases coding definitions. Overall pooled incidence was 9.61% (95% confidence interval 8.33-10.98). Incidence for studies using creatinine definitions was 19.51% (95% confidence interval 12.75-27.32%) and for studies using coding definitions 4.63% (95% confidence interval 3.65-5.72%). Heterogeneity was high throughout. Mortality in stroke patients who sustained acute kidney injury was increased (Odds Ratio 2.45; 95% confidence interval 1.47-4.10). Three studies reported risk factors for acute kidney injury. There was sparse information on other outcomes.

CONCLUSIONS

Mortality in stroke patients who develop acute kidney injury is significantly increased. However the reported incidence of AKI after stroke varies widely and is underestimated using coding definitions. Larger international studies are required to identify potentially preventable factors to reduce acute kidney injury after stroke and improve outcomes.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WJ Urogenital system. Urology
WL Nervous system. Neurology
Divisions: Emergency Services > Neurology
Emergency Services > Renal
Related URLs:
Depositing User: Beth Connors
Date Deposited: 11 Sep 2019 14:46
Last Modified: 11 Sep 2019 14:46
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2380

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