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. 2023 Jul;55(7):1875-1883.
doi: 10.1007/s11255-023-03502-7. Epub 2023 Feb 17.

Acute kidney injury in neurocritical patients: a retrospective cohort study

Gonzalo Ramírez-Guerrero  1   2   3 , Cristian Lucero  4   5 , Francisco Villagrán-Cortés  4   6   5 , Ernesto Hauway  4   5 , Vicente Torres-Cifuentes  4   6   5   7 , Romyna Baghetti-Hernández  4   6   5   8 , Aldo Vera-Calzaretta  9 , Claudio Ronco  10   11 , Osvaldo Garay  4   6   5
Affiliations

Acute kidney injury in neurocritical patients: a retrospective cohort study

Gonzalo Ramírez-Guerrero et al. Int Urol Nephrol. 2023 Jul.

Abstract

Background /objective: Acute kidney injury (AKI) is a significant complication in critical care units (CCU). Non-neurological complications such as AKI are an independent predictor of poor clinical outcomes, with an increase in morbidity and mortality, financial costs, and worse functional recovery. This work aims to estimate the incidence of AKI and evaluate the risk factors and complications of AKI in neurocritical patients hospitalized in the CCU.

Methods: A retrospective cohort study was conducted. Patients admitted to the neurocritical care unit between 2016 and 2018 with a stay longer than 48 h were retrospectively analyzed in regard to the incidence, risk factors, and outcomes of AKI.

Results: The study population comprised 213 neurocritical patients. The incidence of AKI was 23.5%, with 58% KDIGO 1 and 2% requiring renal replacement therapy. AKI was an independent predictor of prolonged use of mechanical ventilation, cerebral edema, and mortality. Cerebral edema [OR 4.40 (95% CI 1.98-9.75) p < 0.001] and a change in chloride levels greater than 4 mmol/L at 48 h (OR 2.44 (95% CI 1.10-5.37) p = 0.027) were risk factors for developing AKI in the first 14 days of hospitalization.

Conclusion: There is a high incidence of AKI in neurocritical patients; it is associated with worse clinical outcomes regardless of the CCU admission etiology or AKI severity.

Keywords: Acute kidney injury; Cerebral hemorrhage; Critical care; Stroke; Subarachnoid hemorrhage; Traumatic brain injury.

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