脑出血后降压药物与急性肾损伤：ATACH-II试验分析
Blood pressure medication and acute kidney injury after intracerebral haemorrhage: an analysis of the ATACH-II trial.
作者信息
Naidech Andrew M, Wang Hanyin, Hutch Meghan, Murphy Julianne, Paparello James, Bath Philip, Srivastava Anand, Luo Yuan
机构信息
Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Health Services Integrated Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
出版信息
BMJ Neurol Open. 2023 Jul 28;5(2):e000458. doi: 10.1136/bmjno-2023-000458. eCollection 2023.
BACKGROUND
Acute blood pressure (BP) reduction is standard of care after acute intracerebral haemorrhage (ICH). More acute BP reduction is associated with acute kidney injury (AKI). It is not known if the choice of antihypertensive medications affects the risk of AKI.
METHODS
We analysed data from the ATACH-II clinical trial. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. We analysed antihypertensive medication from two sources. The first was a case report form that specified the use of labetalol, diltiazem, urapidil or other. We tested the hypothesis that the secondary medication was associated with AKI with χ test. Second, we tested the hypotheses the dosage of diltiazem was associated with AKI using Mann-Whitney U test.
RESULTS
AKI occurred in 109 of 1000 patients (10.9%). A higher proportion of patients with AKI received diltiazem after nicardipine (12 (29%) vs 21 (12%), p=0.03). The 95%ile (90%-99% ile) of administered diltiazem was 18 (0-130) mg in patients with AKI vs 0 (0-30) mg in patients without AKI (p=0.002). There was no apparent confounding by indication for diltiazem use.
CONCLUSIONS
The use of diltiazem, and more diltiazem, was associated with AKI in patients with acute ICH.
背景
急性脑出血（ICH）后急性降低血压（BP）是治疗的标准。更积极的血压降低与急性肾损伤（AKI）相关。尚不清楚抗高血压药物的选择是否会影响AKI的风险。
方法
我们分析了ATACH-II临床试验的数据。AKI根据改善全球肾脏病预后组织（KDIGO）标准定义。我们从两个来源分析抗高血压药物。第一个是病例报告表，其中指定了拉贝洛尔、地尔硫䓬、乌拉地尔或其他药物的使用情况。我们用χ检验验证了二线药物与AKI相关的假设。其次，我们用Mann-Whitney U检验验证了地尔硫䓬剂量与AKI相关的假设。
结果
1000例患者中有109例（10.9%）发生AKI。与使用尼卡地平后发生AKI的患者相比，使用地尔硫䓬的患者比例更高（12例（29%）对21例（12%），p=0.03）。发生AKI的患者中地尔硫䓬的给药量第95百分位数（90%-99%百分位数）为18（0-130）mg，而未发生AKI的患者为0（0-30）mg（p=0.002）。地尔硫䓬使用指征方面无明显混杂因素。
结论
急性ICH患者中使用地尔硫䓬以及更多剂量的地尔硫䓬与AKI相关。
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