Khan Imran, Ifthikhar Mehwash, Hamza Ameer, Jamal Ayesha, Saleem Muhammad Numan, Khan Sheraz J
Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK.
Family Medicine, St. Boniface Hospital, Winnipeg, CAN.
Cureus. 2024 Nov 19;16(11):e73974. doi: 10.7759/cureus.73974. eCollection 2024 Nov.
Background Patients hospitalized with acute stroke are at risk of developing acute kidney injury (AKI), and when both conditions occur together, patient outcomes are often worse. The relationship between stroke type, patient characteristics, and the development of AKI is not fully understood, particularly in tertiary care settings in Pakistan, where healthcare resources and patient characteristics may differ from Western populations. Objective To determine the frequency of AKI and identify associated risk factors, including stroke type, severity, and comorbidities, in patients presenting with acute stroke at a tertiary care center in Pakistan, the Hayatabad Medical Complex, Peshawar. Methods This cross-sectional study was conducted at Hayatabad Medical Complex, Peshawar, from February to July 2023. A total of 214 patients with acute stroke were enrolled through non-probability consecutive sampling. AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria as an increase in serum creatinine by ≥0.3 mg/dL within 48 hours or ≥1.5 times baseline within seven days. Chi-square tests and multivariate logistic regression were used for statistical analysis using IBM SPSS Statistics, Version 23 (IBM Corp., Armonk, NY, USA). Results Among 214 stroke patients (mean age 53.08±7.52 years, 59.8% male), AKI occurred in 33 patients (15.4%, 95% CI: 10.8-20.9). Ischemic strokes (n=147, 68.7%) showed lower AKI prevalence compared to hemorrhagic strokes (10.2% vs 26.9%, p<0.005). AKI occurred in all severe stroke cases (26/26, 100%) but none in mild (0/12) or moderate (0/149) cases (p<0.001). Comorbidity distribution showed isolated hypertension in 9.3%, diabetes in 38.3%, and both conditions in 52.3% of patients. Mean baseline creatinine was 0.98±0.24 mg/dL, with peak levels of 1.42±0.38 mg/dL in the AKI group. Conclusions In our tertiary care setting, AKI occurred in 15.4% of acute stroke patients, with significantly higher rates of hemorrhagic strokes and severe cases. While hypertension and diabetes were common comorbidities, stroke type and severity were stronger predictors of AKI development. These findings suggest the need for targeted monitoring strategies, particularly in patients with hemorrhagic or severe strokes, to facilitate early detection and management of AKI in acute stroke settings.
急性中风住院患者有发生急性肾损伤（AKI）的风险，当这两种情况同时出现时，患者的预后往往更差。中风类型、患者特征与AKI发生之间的关系尚未完全明确，尤其是在巴基斯坦的三级医疗机构中，那里的医疗资源和患者特征可能与西方人群不同。目的：确定巴基斯坦白沙瓦哈亚塔巴德医疗中心急性中风患者中AKI的发生率，并识别相关危险因素，包括中风类型、严重程度和合并症。方法：本横断面研究于2023年2月至7月在白沙瓦哈亚塔巴德医疗中心进行。通过非概率连续抽样共纳入214例急性中风患者。AKI的定义采用改善全球肾脏病预后组织（KDIGO）标准，即48小时内血清肌酐升高≥0.3mg/dL或7天内升高至基线的≥1.5倍。使用IBM SPSS Statistics 23版（美国纽约州阿蒙克市IBM公司）进行卡方检验和多因素逻辑回归分析。结果：在214例中风患者（平均年龄53.08±7.52岁，59.8%为男性）中，33例患者发生AKI（15.4%，95%CI：10.8 - 20.9）。与出血性中风相比，缺血性中风（n = 147，68.7%）的AKI患病率较低（10.2%对26.9%，p < 0.005）。所有严重中风病例均发生AKI（26/26，100%），但轻度（0/12）或中度（0/149）病例均未发生（p < 0.001）。合并症分布显示，9.3%的患者为单纯高血压，38.3%为糖尿病，52.3%的患者两者皆有。AKI组的平均基线肌酐为0.98±0.24mg/dL，峰值水平为1.42±0.38mg/dL。结论：在我们的三级医疗机构中，15.4%的急性中风患者发生AKI，出血性中风和严重病例的发生率显著更高。虽然高血压和糖尿病是常见的合并症，但中风类型和严重程度是AKI发生的更强预测因素。这些发现表明需要有针对性的监测策略，特别是在出血性或严重中风患者中，以便在急性中风情况下促进AKI的早期检测和管理。
