@article{afa1d443bea74243b7ac903d886424fa,
title = "Estimated GFR and the Effect of Intensive Blood Pressure Lowering after Acute Intracerebral Hemorrhage",
abstract = "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 m2, 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.",
keywords = "cerebral hemorrhage, cerebrovascular disease, chronic kidney disease (CKD), dialysis, estimated glomerular filtration rate (EGFR), hemodialysis, intensive blood pressure lowering treatment, INTERACT2, intracerebral hemorrhage (ICH), Kidney function, stroke, systolic blood pressure",
author = "{The INTERACT2 Investigators} and Danni Zheng and Shoichiro Sato and Hisatomi Arima and Emma Heeley and Candice Delcourt and Yongjun Cao and John Chalmers and Anderson, {Craig S.} and S. Davis and Y. Huang and P. Lavados and B. Neal and Parsons, {M. W.} and R. Lindley and L. Morgenstern and T. Robinson and C. Stapf and C. Tzourio and Wang, {J. G.} and S. Chen and X. Chen and L. Cui and Z. Liu and C. Lu and J. Wang and S. Wu and E. Xu and Q. Yang and C. Zhang and J. Zhang and R. Beer and E. Schmutzhard and P. Redondo and M. Kaste and L. Soinne and T. Tatlisumak and K. Wartenberg and S. Ricci and K. Klijn and E. Azevedo and A. Chamorro and M. Arnold and U. Fischer and S. Kaul and J. Pandian and H. Boyini and S. Singh and Rabinstein, {A. A.} and C. Estol and G. Silva and Olavarria, {V. V.} and T. Robinson and Simes, {R. J.} and Bousser, {M. G.} and G. Hankey and K. Jamrozik and Johnston, {S. C.} and S. Li and K. Bailey and T. Cheung and S. Chintapatla and E. Ducasse and T. Erho and J. Hata and B. Holder and E. Knight and M. Leroux and T. Sass{\'e} and E. Odgers and R. Walsh and Z. Wolfowicz and G. Chen and S. Fuentes and B. Peng and Schneble, {H. M.} and Wang, {M. X.} and L. Billot and S. Heritier and Q. Li and M. Woodward and S. Abimbola and S. Anderson and E. Chan and G. Cheng and P. Chmielnik and S. Leighton and Liu, {J. Y.} and B. Rasmussen and A. Saxena and S. Tripathy and M. Armenis and Baig, {M. A.} and B. Naidu and G. Starzec and S. Steley and A. Moles and A. Ruiz and M. Zimmermann and J. Marinho and S. Alves and R. Angelim and J. Araujo and L. Kawakami and C. Bustos and F. Gonzalez and {Munoz Venturelli}, P. and X. Chen and R. Jia and N. Li and S. Qu and Y. Shu and A. Song and J. Sun and J. Xiao and Y. Zhao and Q. Huang and E. Vicaut and A. Chamam and Viaud, {M. C.} and C. Dert and U. Fiedler and V. Jovis and S. Kabla and S. Marchand and A. Pena and V. Rochaud and K. Mallikarjuna and N. Hasan and E. Berge and Sandset, {E C} and For{\aa}rsveen, {A. S.} and D. Richardson and T. Kumar and S. Lewin and N. Poulter and J. Field and A. Anjum and A. Wilson and H. Perelmuter and Agarie, {A. M.} and Barboza, {A. G.} and Recchia, {L. A.} and Miranda, {I. F.} and Rauek, {S. G.} and Duplessis, {R. J.} and H. Dewey and L. Walker and S. Petrolo and C. Bladin and J. Sturm and D. Crimmins and D. Griffiths and A. Schutz and V. Zenteno and F. Miteff and N. Spratt and E. Kerr and Levi, {C. R.} and Phan, {T. G.} and H. Ma and L. Sanders and C. Moran and K. Wong and S. Read and R. Henderson and A. Wong and R. Hull and G. Skinner and P. Hand and B. Yan and H Tu and B. Campbell and Lange, {M. C.} and Y. Li and B. Wang and L. Wang and Liu, {J. Y.} and X. Zhang and H. Jiang and S. Cui and Y. Zhang and F. Yu and Y. Wang and L. Wu and P. Li and Y. Jiang and H. Li and J. Zhou and W. Sun and F. Li and H. Wang and T. Wang and J. Chen and L. Zhang and X. Zhao and G. Zeng and L. Ma and F. Wang and Z. Guo and Y. Fu and X. Liu and L. Su and T. Xu and N. Zhao and L. Li and Z. Li and X. Xu and Y. Lian and D. Liu and N. Wang and C. Liu and L. Sun and X. Tian and X. Wang and X. Li and R. Wang and Z. Wei and Y. Cheng and Z. Zhang and J. Zhu and Y. Sun and Q. Zhang and C. Wang and R. Lu and S. Zhang and M. Li and W. Wei and C. Rossi and C. Beck and K. Wong and T. Mathew and D. Day and A. Steele and P. Murphy and E. Brown and G. Pope and K. Michael and R. Lewis and C. Bedford and M. Harvey and P. Bourke and D. Morgan and C. Price and M. James and D. Button and J. Davis and J. O'Reilly and R. Perry and I. Jones and J. Lucas and R. Marsh",
year = "2016",
month = jul,
day = "1",
doi = "10.1053/j.ajkd.2016.01.020",
language = "English",
volume = "68",
pages = "94--102",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "American Journal of Kidney Diseases",
number = "1",
}