1018. Acute kidney injury, chronic kidney disease, and outcome after aneurysmal subarachnoid hemorrhage

Authors: Matthew E. Eagles, MD; Maria Powell, MD; Michael Tso, MD, PhD; Oliver Ayling, MD, MSc; R. Loch Macdonald, MD, PhD (Calgary, Canada)

Introduction:
Acute kidney injury (AKI) and chronic kidney disease (CKD) are associated with poor outcomes in critically ill patients. The objective of this study was to examine the effect of renal dysfunction on prognosis for patients who suffer aneurysmal subarachnoid hemorrhage (aSAH).

Methods:
We performed a post-hoc analysis of the Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1) dataset. Participants had their creatinine measured at admission and daily for the entirety of their ICU stay. The primary outcome was poor functional outcome, defined as a modified Rankin Scale (mRS) greater than 2 at 3-months post aSAH. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. CKD was defined as a glomerular filtration rate less than 90 ml/min/1.73 m² according to the Modification of Diet in Renal Disease Study (MDRD) equation based on the patients’ initial creatinine value. Locally weighted scatterplot smoothing (LOWESS) curves were used to visualize the relationship between increasing creatine and poor outcome. A stepwise logistic regression model was created to evaluate whether AKI and CKD were independent predictors of poor outcome at 3-months.

Results:
Of the 413 patients enrolled in the CONSCIOUS-1 study, 138 (33%) developed an AKI and 38 (9%) met the criteria for CKD based on their initial creatinine value. Higher percent changes in creatinine from baseline values (p = 0.03), CKD (p = 0.03), and acute on chronic kidney injury (p = 0.02) were significant predictors of poor outcome on univariate and multivariate analysis. AKI was associated with poor outcome on univariate, but not multivariate analysis (p = 0.12).

Conclusion:
Kidney dysfunction appears to be associated with poor outcome following aSAH. Practitioners should be cautious when treating patients with CKD and take measures to prevent them developing an AKI.