Higher baseline serum creatinine levels and treatment with higher doses of the antihypertensive drug nicardipine increase the risk for acute kidney injury (AKI) in patients with intracerebral hemorrhage (ICH), according to a new study.

In addition, development of AKI is associated with higher rates of death and death or disability combined at 90 days.

“New strategies aimed at reducing the risk of AKI in patients with ICH may reduce the rates of death or disability associated with ICH,” Adnan I. Qureshi, MD, of the University of Missouri-Columbia, and colleagues concluded in a paper published in Stroke.

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The study included 1000 patients with intracerebral hemorrhage in a clinical trial who had initial systolic blood pressure (SBP) values of 180 mm Hg or higher and were randomly assigned to intensive (goal 110-139 mm Hg) or standard (goal 140-179 mm Hg) SBP reduction within 4.5 hours of symptom onset. Investigators identified AKI by serial assessment of daily serum creatinine for 3 days after randomization.

AKI and renal adverse events (AEs), such as acute renal failure and abnormal renal function tests, developed in 149 patients (14.9%) and 65 patients (6.5%), respectively. On multivariate analysis, higher baseline serum creatinine (110 µmol/L or higher) was associated with significant 2.4-fold (95% CI, 1.2-4.5) and 3.1-fold (95% CI, 2.0-8.1) increased odds of AKI and renal AEs, respectively, compared with levels less than 60 µmol/L, Dr Qureshi and colleagues reported.

A higher area under the curve for intravenous nicardipine was associated with greater risk for AKI (95% CI, 1.001-1.005) and renal AEs (95% CI, 1.001-1.006). “Higher doses of nicardipine may be a marker of more difficult to treat elevated SBP or may have a direct effect by decreasing renal vascular resistances and increasing transmission of SBP to the glomeruli,” the authors explained.

The study found no relationship between any SBP reduction parameters with the development of AKI or renal AEs.

The proportion of patients who died within 90 days was significantly higher in the AKI than no-AKI group (14.1% vs 5.4%). The proportion of patients who died or experienced disability also was higher in the AKI group (53.0% vs 33.8%). In adjusted analyses, the presence of AKI, compared with its absence, was associated with a 2.9-fold greater risk for death at 90 days (95% CI, 1.6-5.5) and a 2.7-fold greater risk for death or disability at 90 days (95% CI, 1.7-4.1), according to the investigators. Renal AEs were not associated with either of those outcomes.


Qureshi AI, Huang W, Lobanova I, et al. Systolic blood pressure reduction and acute kidney injury in intracerebral hemorrhage. Stroke. 2020;51:3030-3038. doi:10.1161/STROKEAHA.120.030272