Epidemiology and Outcome of Early Acute Kidney Injuries in Patients with Acute Intracerebral Hemorrhage Admitted to the Apex Neurosciences Center in Dubai.

Abstract

Objectives: To investigate the incidence, etiological factors, predictors, and clinical outcomes of acute kidney injury (AKI) in patients with acute intracerebral hemorrhage (ICH).

Methods: This retrospective cohort study included patients with ICH who were admitted to the ICU of Rashid Hospital, Dubai, between 2019 and 2024. Patients were grouped into AKI and non-AKI groups depending on the occurrence of AKI according to KDIGO clinical practice guidelines. Demographic characteristics, comorbidities, potential risk factors, and clinical outcomes were compared between both groups.

Results: A total of 418 patients were included (median age: 44 years; males: 79.2%). Of these, 138 patients developed AKI (33%). AKI was more common in patients with spontaneous ICH (P = 0.016), males with hypertensive crisis, lower Glasgow Coma Scale (GCS) scores, and higher APACHE II scores (for all, P < 0.001). Significant etiological factors included hypertensive crisis (P = 0.005), hypotension (P = 0.024), high intracranial pressure (P = 0.004), blood transfusion (P = 0.002), diabetes insipidus (P < 0.001), and rhabdomyolysis (P = 0.017). Lower GCS scores on admission was associated with AKI (r_pb : -0.23; P < 0.001). Factors that were independently associated with the development of early AKI were history of chronic kidney disease (OR: 4.79, 95% CI: 2.29-10.04; P < 0.001), diabetes insipidus (OR: 3.97, 95% CI: 1.95-8.10; P < 0.001), and hypertensive crisis (OR: 2.09, 95% CI: 1.21-3.61; P < 0.008). AKI was associated with lower GCS score at ICU discharge (P < 0.001) and increased length of ICU stay (P = 0.017), requirement for and duration of mechanical ventilation, incidence of brain death, 28-day mortality (for all, P < 0.001), and >28-day mortality (P = 0.004).

Conclusions: Acute kidney injury (AKI) develops in about one third of patients with acute intracerebral hemorrhage (ICH). Lower GCS score, chronic kidney disease history, diabetes insipidus and hypertensive crisis are independently associated with increased odds of AKI. AKI is associated with an increase in morbidity and mortality in ICH patients.