Arnold, Julia, Ng, Khai Ping, Sims, Don, Gill, Paramjit, 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 . 283. doi:10.1186/s12882-018-1085-0 ISSN 1471-2369.

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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.

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.

This systematic review was registered with PROSPERO (CRD42017064588).

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Cerebrovascular disease, Kidneys -- Wounds and injuries
Journal or Publication Title:	BMC Nephrology
Publisher:	BioMed Central Ltd.
ISSN:	1471-2369
Official Date:	22 October 2018
Dates:	Date Event 22 October 2018 Published 8 October 2018 Accepted
Volume:	19
Article Number:	283
DOI:	10.1186/s12882-018-1085-0
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	12 October 2018
Date of first compliant Open Access:	18 December 2018
Related URLs:	Publisher

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