机构：[1]The George Institute for Global Health,University of Sydney, Sydney, Australia[2]Sydney Medical School, University of Sydney, Sydney, Australia[3]Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Otsu, Japan[4]Royal Prince Alfred Hospital, Sydney, Australia[5]Department of Neurology, The Second Affiliated Hospital of Suzhou University, Suzhou, China.
Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-based (target SBP, 180 mm Hg) BP management. Setting & Participants: 2,823 patients from 144 clinical hospitals in 21 countries. Predictors: Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (>90, 60-90, and <60 mL/min/ 1.73 m(2), respectively). Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.
基金：
INTERACT2 was supported by Program (571281) and
Project (512402 and 1004170) grants from the National Health and Medical Research Council (NHMRC) of Australia.
第一作者机构：[1]The George Institute for Global Health,University of Sydney, Sydney, Australia[2]Sydney Medical School, University of Sydney, Sydney, Australia
通讯作者：
通讯机构：[*1]The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia.
推荐引用方式(GB/T 7714)：
Danni Zheng ,Shoichiro Sato ,Hisatomi Arima ,et al.Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage[J].AMERICAN JOURNAL OF KIDNEY DISEASES.2016,68(1):94-102.doi:10.1053/j.ajkd.2016.01.020.
APA：
Danni Zheng,,Shoichiro Sato,,Hisatomi Arima,,Emma Heeley,,Candice Delcourt,...&Craig S. Anderson,.(2016).Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage.AMERICAN JOURNAL OF KIDNEY DISEASES,68,(1)
MLA：
Danni Zheng,,et al."Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage".AMERICAN JOURNAL OF KIDNEY DISEASES 68..1(2016):94-102
医学