Ulyanovsk Medico-biological Journal

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2021-1-26-38

 

PROGNOSTIC VALUE OF ACUTE KIDNEY INJURY IN STROKE PATIENTS

 

A.M. Gerdt¹, A.M. Shutov², L.A. Belova², E.A. Gubareva³

1 Integra Clinic, Togliatti, Russia;

2 Ulyanovsk State University, Ulyanovsk, Russia;

3 Togliatti city clinical hospital № 2 named after V.V. Banykin, Togliatti, Russia

 

The development of acute kidney injury (AKI) in stroke patients is associated with an increase in hospital mortality, period of hospital treatment, disability, and economic health costs. At the same time, the influence of AKI on long-term stroke outcomes remains unclear.

The aim of the study was to determine the prognostic value of acute kidney damage in stroke patients.

Materials and Methods. The authors examined 272 stroke patients. Acute kidney damage was established according to the KDIGO recommendations (2012). Mortality of stroke patients during hospital treatment was 20.6 %. The prospective follow-up of stroke patients discharged from the hospital was 12 months.

Results. Acute kidney injury was diagnosed in 89 (32.7 %) stroke patients. After discharging from the hospital, 45 (20.8 %) patients died within 12 months. The relative risk of death within 12 months after stroke in the group of AKI patients was 3.7 (95 % CI 2.2–6.2, p<0.001) if compared with patients without AKI.

Multivariate analysis did not show any independent statistically significant correlation between AKI history and patients’ death within 12 months after hemorrhagic stroke. However, such a correlation was evident in ischemic stroke.

Conclusions. Acute kidney injury, developed in the acute period, increases the 12-month mortality in ischemic stroke patients.

Keywords: prognosis, stroke, acute kidney injury.

Conflict of interest. The authors declare no conflict of interest.

 

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Received 14 January 2021; accepted 03 March 2021.

 

Information about the authors

Gerdt Alevtina Mikhaylovna, Physician, Integra Clinic. 445020, Russia, Samara region, Togliatti, Banykin St., 21a; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-8136-0803

Shutov Aleksandr Mikhaylovich, Doctor of Sciences (Medicine), Professor, Head of the Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-1213-8600

Belova Lyudmila Anatol'evna, Doctor of Sciences (Medicine), Professor, Dean of the Medical Faculty named after T.Z. Biktimirov, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9585-5604

Gubareva Elena Aleksandrovna, Neurologist, Togliatti City Clinical Hospital № 2 named after V.V. Banykin. 445020, Russia, Samara region, Togliatti, Banykin St., 8; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9476-1358

 

For citation

Gerdt A.M., Shutov A.M., Belova L.A., Gubareva E.A. Prognosticheskoe znachenie ostrogo povrezhdeniya pochek u bol'nykh insul'tom [Prognostic value of acute kidney injury in stroke patients]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2021; 1: 26–38. DOI: 10.34014/2227-1848-2021-1-26-3 (in Russian).

 

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УДК 616.61+616.831-005

DOI 10.34014/2227-1848-2021-1-26-38

 

ПРОГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК У БОЛЬНЫХ ИНСУЛЬТОМ

 

А.М. Гердт¹, А.М. Шутов², Л.А. Белова², Е.А. Губарева³

¹ ООО «Клиника Интегра», г. Тольятти, Россия;

² ФГБОУ ВО «Ульяновский государственный университет, г. Ульяновск, Россия;

³ ГБУЗ СО «Тольяттинская городская клиническая больница № 2 им. В.В. Баныкина», г. Тольятти, Россия

 

Развитие ОПП у больных с инсультом ассоциируется с увеличением госпитальной летальности, сроков стационарного лечения, инвалидизации и экономических затрат здравоохранения. При этом остается неясным влияние ОПП на отдаленные исходы инсульта.

Целью исследования явилось определение прогностического значения острого повреждения почек у больных с инсультом.

Материалы и методы. Обследовано 272 больных с инсультом. Острое повреждение почек устанавливали согласно «Рекомендациям KDIGO» (2012). Летальность у больных с инсультом в период стационарного лечения составила 20,6 %. Срок проспективного наблюдения за больными инсультом, выписанными из стационара, составил 12 мес.

Результаты. Острое повреждение почек было диагностировано у 89 (32,7 %) больных инсультом. За 12 мес. наблюдения за больными, выписанными из стационара, умерло 45 (20,8 %) пациентов. Относительный риск смерти в течение 1-го года после инсульта в группе больных с ОПП составил 3,7 (95 % ДИ 2,2–6,2, p<0,001) в сравнении с больными без ОПП.

Независимая статистически значимая связь между ОПП в анамнезе и летальным исходом в течение года после геморрагического инсульта в многофакторном анализе не прослеживалась, в отличие от ишемического инсульта.

Выводы. Острое повреждение почек, развившееся в остром периоде, повышает годичную летальность у больных с ишемическим инсультом.

Ключевые слова: прогноз, инсульт, острое повреждение почек.

 

Литература

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  2. Zorrilla-Vaca A., Ziai W., Connolly E., Geocadin R., Thompson R., Rivera-Lara L. Acute Kidney Injury Following Acute Ischemic Stroke and Intracerebral Hemorrhage: A Meta-Analysis of Prevalence Rate and Mortality Risk. Cerebrovasc. Dis. 2018; 45 (1–2): 1–9. URL: https://www.karger.com/Article/Abstract/479338 (дата обращения: 24.11.2020). DOI: 10.1159/000479338.

  3. Мензоров М.В., Шутов А.М., Лукьянова В.А., Гердт А.М., Гришенькин И.Ю. Острое повреждение почек у больных с инсультом. Нефрология. 2014; 18 (2): 55–60. DOI: 10.24884/1561-6274-2014-18-2-50-68.

  4. Jiang F., Su L., Xiang H., Zhang X., Xu D., Zhang Z., Peng Z. Incidence, Risk factors, and Biomarkers Predicting Ischemic or Hemorrhagic Stroke Associated Acute Kidney Injury and Outcome: A Retrospective Study in a General Intensive Care Unit. Blood Purif. 2019; 47 (4): 317–326. URL: https://www.karger.com/Article/Abstract/499029 (дата обращения: 19.03.2020). DOI:10.1159/000499029.

  5. Pistoia F., Sacco S., Degan D., Tiseo C., Ornello R., Carolei A. Hypertension and Stroke: Epidemiolo­gical Aspects and Clinical Evaluation. High Blood Press. Cardiovasc. Prev. 2016; 23 (1): 9–18. URL: https://link.springer.com/article/10.1007/s40292-015-0115-2 (дата обращения: 10.07.2018). DOI: 10.1007/s40292-015-0115-2.

  6. Smajlovic D. Strokes in young adults: epidemiology and prevention. Vasc. Health Risk Manag. 2015; 11: 157–164. URL: https://www.dovepress.com/strokes-in-young-adults-epidemiology-and-prevention-peer-reviewed-article-VHRM (дата обращения: 24.12.2018). DOI: 10.2147/VHRM.S53203.

  7. Kim J., Thayabaranathan T., Donnan G., Howard G., Howard V., Rothwell P., Feigin V., Norrving B., Owolabi M. Global Stroke Statistics 2019. Int. J. Stroke. 2020; 15 (8): 819– 838. URL: https://journals.sagepub.com/doi/10.1177/1747493020909545 (дата обращения: 14.12.2020). DOI: 10.1177 /1747493020909545.

  8. Roth G., Mensah G., Johnson C., Addolorato G. GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. J. Am. Coll. Cardiol. 2020; 76 (25): 2982–3021. URL: https://www.sciencedirect.com/science/article/pii/S0735109720377755?via %3Dihub (дата обращения: 14.12.2020). DOI: 10.1016/j.jacc.2020.11.010.

  9. Thrift A., Howard G., Cadilhac D., Howard V., Rothwell P., Thayabaranathan T., Feigin V., Norrving B., Donnan G. Global stroke statistics: An update of mortality data from countries using a broad code of "cerebrovascular diseases". Int. J. Stroke. 2017; 12 (8): 796–801. URL: https://journals.sagepub.com/doi/10.1177/1747493017730782 (дата обращения: 12.09.2020). DOI: 10.1177/1747493017730782.

  10. Vandenberghe W., Gevaert S., Kellum J., Bagshaw S., Peperstraete H., Herck I., Decruyenaere J., Hoste E. Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis. Cardiorenal. Med. 2016; 6 (2): 28–116. URL: https://www.karger.com/Article/FullText/442300 (дата обращения: 19.12.2020). DOI:10.1159/000442300.

  11. Moriyama N., Ishihara M., Noguchi T., Nakanishi M., Arakawa T., Asaumi Y., Kumasaka L., Kanaya T., Nagai T., Fujino M., Honda S., Fujiwara R., Anzai T., Kusano K., Goto Y., Yasuda S., Saito S., Ogawa H. Early development of acute kidney injury is an independent predictor of in-hospital mortality in patients with acute myocardial infarction. J. Cardiol. 2017; 69 (1): 79–83. URL: https://www.journal-of-cardiology.com/article/S0914-5087(16)00011-3/fulltext (дата обращения: 13.12.2020). DOI: 10.1016 /j.jjcc.2016.01.001.

  12. Khatri M., Himmelfarb J., Adams D., Becker K., Longstreth W., Tirschwell D. Acute Kidney Injury is Associated with Increased Hospital Mortality after Stroke. J. Stroke Cerebrovasc. Dis. 2014; 23 (1): 25–30. URL: https://www.strokejournal.org/article/S1052-3057(12)00151-6/fulltext (дата обращения: 17.07.2018). DOI: 10.1016/j.jstrokecerebrovasdis.2012.06.005.

  13. Saeed F., Adil M., Khursheed F., Daimee U.A., Branch L., Vidal G., Qureshi A. Acute renal failure is associated with higher death and disability in patients with acute ischemic stroke: analysis of nationwide inpatient sample. Stroke. 2014; 45 (5): 78–80. URL: https://www.ahajournals.org/doi/10.1161/STROKEAHA.114.004672. (дата обращения: 11.03.2018). DOI: 10.1161/STROKEAHA.114.004672.

  14. Gadalean F., Simu M., Parv F., Vorovenci R., Tudor R., Schiller A., Timar R., Petrica L., Velciov S., Gluhovschi C., Bob F., Mihaescu A., Timar B., Spasovski G., Ivan V. The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis. PLoS One. 2017; 12 (10). URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185589 (дата обращения: 17.10.2020). DOI: 10.1371/journal.pone.0185589.

  15. Saeed F., Adil M., Piracha B., Qureshi A. Acute renal failure worsens in-hospital outcomes in patients with intracerebral hemorrhage. J. Stroke Cerebrovasc. Dis. 2015; 24 (4): 789–794. URL: https://www.strokejournal.org/article/S1052-3057(14)00570-9/fulltext (дата обращения: 11.02.2020). DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.012.

  16. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc. Dis. 2008; 25 (5): 457–507. URL: https://www.karger.com/Article/FullText/131083 (дата обращения: 6.05.2018). DOI: 10.1159/000131083.

  17. Avasarala J. Letter by Avasarala Regarding Article, "American Stroke Association. AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment. A Guideline for Healthcare Professionals from the American Heart Association". Stroke. 2015; 46 (11). URL: https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.010716 (дата обращения: 06.10.2018). DOI: 10.1161/STROKEAHA.115.010716.

  18. Adams H., Bendixen B., Kappelle L., Biller J., Love B., Gordon D., Marsh E. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. toast. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24 (1): 35–41. DOI: 10.1161/01.str.24.1.35.

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Поступила в редакцию 14.01.2021; принята 03.03.2021.

 

Авторский коллектив

Гердт Алевтина Михайловна – врач-терапевт, ООО «Клиника Интегра». 445020, Россия, Самарская обл., г. Тольятти, ул. Баныкина, 21а; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-8136-0803

Шутов Александр Михайлович – доктор медицинских наук, профессор, заведующий кафедрой терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-1213-8600

Белова Людмила Анатольевна – доктор медицинских наук, профессор, декан медицинского факультета им. Т.З. Биктимирова, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9585-5604

Губарева Елена Александровна – врач-невролог, ГБУЗ СО «Тольяттинская городская клиническая больница № 2 им. В.В. Баныкина». 445020, Россия, Самарская обл., г. Тольятти, ул. Баныкина, 8; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9476-1358

 

Образец цитирования

Гердт А.М., Шутов А.М., Белова Л.А., Губарева Е.А. Прогностическое значение острого повре­жде­ния почек у больных инсультом. Ульяновский медико-биологический журнал. 2021; 1: 26–38. DOI: 10.34014/2227-1848-2021-1-26-38.