Background: The epidemiology of acute renal dysfunction after stroke is routinely overlooked following stroke events. Our aim in this meta-analysis is to report the prevalence of acute kidney injury (AKI) following acute stroke and its impact on mortality. Methods: A systematic literature search was performed on PubMed, EMBASE and Google Scholar for observational studies examining the prevalence and mortality risk of stroke patients with AKI as a complication. The pooled prevalence rates and odds ratios for mortality risk were calculated using subgroup analyses between the stroke subtypes: acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). Results: A total of 12 studies (4,532,181 AIS and 615,636 ICH) were included. The pooled prevalence rate of AKI after all stroke types was 11.6% (95% CI 10.6–12.7). Subgroup analyses revealed that the pooled prevalence rate of AKI after AIS was greater but not statistically significantly different than ICH (19.0%; 95% CI 8.2–29.7 vs. 12.9%; 95% CI 10.3–15.5, p = 0.5). AKI was found to be a significant risk factor of mortality in AIS (adjusted OR [aOR] 2.23; 95% CI 1.28–3.89; I2 = 98.8%), whereas this relationship did not reach statistical significance in ICH (aOR 1.20; 95% CI 0.68–2.12; I2 = 74.2%). Conclusions: This meta-analysis provides evidence that AKI is a common complication following both AIS and ICH and it is associated with increased mortality following AIS but not ICH. This highlights the need for early assessment of renal function in the acute phase of AIS, in particular, and avoidance of factors than may induce AKI in vulnerable patients.

Keywords:
Acute stroke, Acute kidney injury, Kidney dysfunction, Prevalence, Mortality
1.
Singbartl K, Kellum JA: AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012; 81: 819–825.
2.
Kume K, Yasuoka Y, Adachi H, Noda Y, Hattori S, Araki R, et al: Impact of -contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med 2013; 14: 253–257.
3.
Waikar SS, Liu KD, Chertow GM: Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008; 3: 844–861.
4.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294: 813–818.
5.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1–138.
6.
Rewa O, Bagshaw SM: Acute kidney injury-epidemiology, outcomes and economics. Nat Rev Nephrol 2014; 10: 193–207.
7.
Khatri M, Himmelfarb J, Adams D, Becker K, Longstreth WT, Tirschwell DL: Acute kidney injury is associated with increased hospital mortality after stroke. J Stroke Cerebrovasc Dis 2014; 23: 25–30.
8.
Saeed F, Adil MM, Piracha BH, Qureshi AI: Acute renal failure worsens in-hospital outcomes in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2015; 24: 789–794.
9.
Patel A, Nadkarni G, Benjo A, Agarwal SK, Konstantinidis I, Simoes P, et al: Temporal trends of outcomes for acute kidney injury in acute ischemic stroke from 2002 to 2012: an analysis of nationwide inpatient sample data. J Am Coll Cardiol 2015; 65:A2094.
10.
Tsagalis G, Akrivos T, Alevizaki M, Manios E, Stamatellopoulos K, Laggouranis A, et al: Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrol Dial Transplant 2009; 24: 194–200.
11.
Covic A, Schiller A, Mardare NG, Petrica L, Petrica M, Mihaescu A, et al: The impact of acute kidney injury on short-term survival in an Eastern European population with stroke. Nephrol Dial Transplant 2008; 23: 2228–2234.
12.
Gerdt A, Shutov A, Menzorov M, Vastyanov M: Association between Acute Kidney Injury and Unfavorable Outcomes in Acute Stroke, 2014 (abstract).
13.
Hamed SA, Youssef AH, Tohamy AM, Elaal RFA, Mahmoud M, and Eldin EN. Acute kidney injury in patients with cerebrovascular stroke and its relationship to short-term mortality. Int Res J Med Med Sci 2015; 3: 70–77.
14.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Loannidis J: The PRISMA statement for reporting systemaic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6:e1000100.
15.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al; Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11:R31.
16.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010; 50: 1088–1101.
17.
Kong FY, Tao WD, Hao ZL, Liu M: Predictors of one-year disability and death in Chinese hospitalized women after ischemic stroke. Cerebrovasc Dis 2010; 29: 255–262.
18.
Friedman PJ: Serum creatinine: an independent predictor of survival after stroke. J Intern Med 1991; 229: 175–179.
19.
Harvey A, Montezano AC, Touyz RM: Vascular biology of ageing-Implications in hypertension. J Mol Cell Cardiol 2015; 83: 112–121.
20.
Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES, et al: Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41: 2108–2129.
21.
Powers WJ, Videen TO, Diringer MN, Aiyagari V, Zazulia AR: Autoregulation after ischaemic stroke. J Hypertens 2009; 27: 2218–2222.
22.
Ono M, Arnaoutakis GJ, Fine DM, Brady K, Easley RB, Zheng Y, et al: Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acute kidney injury. Crit Care Med 2013; 41: 464–471.
23.
Saeed F, Adil MM, Khursheed F, Daimee UA, Branch LA, Vidal GA, et al: Acute renal failure is associated with higher death and disability in patients with acute ischemic stroke: analysis of nationwide inpatient sample. Stroke 2014; 45: 1478–1480.
24.
Osgood M, Compton R, Carandang R, Hall W, Kershaw G, Muehlschlegel S: Rapid unexpected brain herniation in association with renal replacement therapy in acute brain injury: caution in the neurocritical care unit. Neurocrit Care 2015; 22: 176–183.
25.
Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al: The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 2011; 80: 17–28.
26.
Kamouchi M, Sakai H, Kiyohara Y, Minematsu K, Hayashi K, Kitazono T: Acute kidney injury and edaravone in acute ischemic stroke: the Fukuoka Stroke Registry. J Stroke Cerebrovasc Dis 2013; 22:e470–e476.
27.
Power A, Epstein D, Cohen D, Bathula R, Devine J, Kar A, et al: Renal impairment reduces the efficacy of thrombolytic therapy in acute ischemic stroke. Cerebrovasc Dis 2013; 35: 45–52.
28.
Micozkadioglu H: Higher diastolic blood pressure at admission and antiedema therapy is associated with acute kidney injury in acute ischemic stroke patients. Int J Nephrol Renovasc Dis 2014; 7: 101–105.
29.
Shimoyama T, Komatsu T, Mitsumura H, Kono Y, Iguchi Y: Abstract T P136: acute kidney injury is independently associated with hyperglycemia and poor clinical outcome in acute ischemic stroke patients. Stroke 2015; 46:ATP136.
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2017
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