Decreased eGFR correlates with poorer outcomes after intracerebral hemorrhage

Following an intracerebral hemorrhage, decreased estimated glomerular filtration rate correlated with poor outcomes, according to study results published in Neurology.

“[In] the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) study, which investigated the efficacy of intensive (target 110–139 mmHg) versus standard (target 140–179 mmHg) [systolic blood pressure (SBP)]-lowering initiated within 4.5 [hours] after symptom onset, intensive SBP-lowering therapy did not improve the functional outcomes but raised concerns for renal adverse events (AEs),” Mayumi Fukuda-Doi, MD, MPH, PhD, of the department of cerebrovascular medicine at the National Cerebral and Cardiovascular Center in Japan, and colleagues wrote. “The intensive treatment group had a two-fold higher rate of renal AEs than the standard treatment group (9% vs. 4%). These findings suggest that the safety of intensive SBP-lowering therapy in acute [intracerebral hemorrhage (ICH)] remains a concern, especially among patients with [chronic kidney disease (CKD)]. Understanding the impact of renal function on clinical outcomes and treatment is crucial when selecting the target population of intensive SBP-lowering therapy. Therefore, using the ATACH-2 trial data, this study aimed to explore the impact of eGFR on clinical outcomes and its interaction with intensive BP-lowering treatment among patients with ICH.”

Fukuda-Doi and colleagues performed a post-hoc analyses of the ATACH-2 open-label trial among 1,000 patients with ICH, of which 974 were assessed. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate the baseline eGFR. Death or disability at 90 days served as the study’s outcome of interest. The researchers used multivariate logistic regression models for analysis.

Investigators noted a median baseline eGFR of 88 ml/min/1.73 m². Fukuda-Doi and colleagues observed that 451 patients (46.3%) had baseline eGFR values of 90 or more ml/min/1.73 m², 363 (37.3%) had 60-89 ml/min/1.73 m² and 160 (16.4%) had less than 60 ml/min/1.73 m².

The researchers observed higher odds of death or disability among patients with eFGR values of <60 ml/min/1.73 m² (adjusted OR, 2.02; 95% CI, 1.25-3.26), but not among those with eGFR values of 60-89 ml/min/1.73 m² (OR, 1.01; 95% CI, 0.7–1.46).

Fukado-Doi and colleagues found that the likelihood of death or disability were “significantly” higher in the intensive arm in patients with decreased eGFR (P for interaction = .02). In patients with eGFR values of 90 or more ml/min/1.73 m², the OR was 0.89 (95% CI, 0.55–1.44); in those with eGFR values of 60-89 ml/min/1.73 m², the OR was 1.13 (0.68–1.89), and, among those with eGFR values of less than 60 ml/min/1.73 m², it was 3.6 (1.47–8.8).

“Furthermore, eGFR significantly modified the risk of intensive SBP lowering in acute ICH, and intensive SBP-lowering is potentially harmful among patients with decreased eGFR,” Fukuda-Doi and colleague wrote. “Further studies are required to address the optimal SBP target according to the baseline eGFR.”