Effect of Chronic Kidney Disease on Inpatient Outcomes of Primary Intracerebral Hemorrhage

Introduction: Primary spontaneous intracerebral hemorrhage (ICH) in patients with pre-existing chronic kidney disease (CKD) is associated with worse outcomes. Associated medical comorbidities might further worsen the outcome in this group of patients, however, there is limited literature on this topic. The purpose of this study was to compare a variety of patient characteristics that may be predictive of poor outcomes in primary ICH patients with and without a history of CKD.

Methods: This retrospective study evaluated 814 patients admitted to Stony Brook Hospital from January 2011 to December 2022 with a diagnosis of primary ICH. Ninety patients (11%) were identified to have CKD at baseline. Medical history, admission laboratory values, in-patient mortality, radiographic findings, hospital length of stay as well as admission and discharge Glasgow Coma Scale (GCS) and Modified Rankin Scale (MRS) scores were recorded and compared between two groups.

Results: Primary outcomes including inpatient mortality (31.1% n=28), length of stay (15.8 days) and mean GCS at discharge (9.9) were significantly worse amongst CKD patients when compared to non-CKD patients. Comorbidities that were more prevalent amongst CKD patients included hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, heart failure and peripheral vascular disease as well as a prior history of stroke, ICH, and myocardial infarction. Higher HbA1c and lower hemoglobin levels were also observed in CKD patients compared to non-CKD patients. Finally, a multivariate regression model of age, admission MRS, diabetes mellitus, hematoma volume, CKD, and acute kidney injury was statistically significant with CKD reliably predicting inpatient mortality (β=0.122, p< 0.001).

Conclusion : Results of this retrospective study indicates CKD is an independent predictor of poor outcome in primary ICH patients. Associated medical comorbidities might exacerbate this poor outcome. Further prospective studies on this topic are needed.