Title :

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

Author(s) :

Zheng, Danni [Auteur]
Sato, Shoichiro [Auteur]
Arima, Hisatomi [Auteur]
Heeley, Emma [Auteur]
Delcourt, Candice [Auteur]
Cao, Yongjun [Auteur]
Chalmers, John [Auteur]
Anderson, Craig S. [Auteur]

Journal title :

American journal of kidney diseases . the official journal of the National Kidney Foundation

Abbreviated title :

Am. J. Kidney Dis.

Volume number :

68

Pages :

94-102

Publication date :

2016-07-01

ISSN :

1523-6838

English keyword(s) :

INTERACT2
intensive blood pressure lowering treatment
systolic blood pressure
cerebrovascular disease
stroke
cerebral hemorrhage
intracerebral hemorrhage (ICH)
stroke
hemodialysis
Kidney function
dialysis
chronic kidney disease (CKD)
estimated glomerular filtration rate (eGFR)

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

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, ...
Show more >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. METHODS: 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. METHODS: 2,823 patients from 144 clinical hospitals in 21 countries. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
CNRS
Inserm
Université de Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172

Research team(s) :

Troubles cognitifs dégénératifs et vasculaires

Submission date :

2019-11-27T13:33:51Z