Abstract
Objective: The need for continuous renal replacement therapy (CRRT) in patients with deep-seated intracerebral hemorrhage (ICH) requires sustained intensive care and often postpones further rehabilitation therapy. Therefore, an early identification of patients at risk is essential.Methods: From 2014 to 2019, all patients with deep-seated ICH who were admitted to intensive care for >3 days were included in the further analysis and retrospectively reviewed for the need for CRRT. All patients underwent CRRT with regional citrate anticoagulation for continuous veno-venous hemodialysis (CVVHD). Outcome was evaluated after 3 months using the modified Rankin scale. A multivariate analysis was performed to identify potential predictors for CRRT in patients with deep-seated ICH.Results: After applying the inclusion criteria, a total of 87 patients with deep-seated spontaneous ICH were identified and further analyzed. During the first 48 h after admission, 21 of these patients developed early acute kidney injury (AKI; 24%). During treatment course, CRRT became necessary in nine patients suffering from deep-seated ICH (10%). The multivariate analysis revealed “development of AKI during the first 48 h” [p = 0.025, odds ratio (OR) 6.1, 95% confidence interval (CI) 1.3–29.8] and “admission procalcitonin (PCT) value >0.5 μg/l” (p = 0.02, OR 7.7, 95% CI 1.4–43.3) as independent and significant predictors for CRRT in patients with deep-seated ICH.Conclusions: Elevated serum levels of procalcitonin on admission as well as early development of acute renal injury are independent predictors of the need for renal replacement therapy in patients with deep-seated intracerebral bleeding. Therefore, further research is warranted to identify these vulnerable patients as early as possible to enable adequate treatment.
Highlights
Acute renal injury (AKI) is a frequent and devastating complication with high morbidity and mortality in patients requiring treatment in an intensive care unit (ICU)
continuous renal replacement therapy (CRRT) became necessary in nine patients suffering from deep-seated Intracerebral hemorrhage (ICH) (10%)
CRRT was required on median day 9 after admission
Summary
Acute renal injury (AKI) is a frequent and devastating complication with high morbidity and mortality in patients requiring treatment in an intensive care unit (ICU). With regard to neurological diseases, the presence of chronic kidney disease (CKD) in patients with acute stroke (ischemic/hemorrhagic) was identified as a strong independent predictor for both mortality and adverse outcomes [3]. Both the increased appearance of atherosclerotic alterations and a less effective dynamic cerebral autoregulation in acute stroke were discussed as potential explanations for this correlation [3, 4]. The need for CRRT in patients with ICH requires continued intensive care treatment and often results in further postponement of a potential rehabilitation therapy. This highlights the need for early identification and treatment of these endangered patients
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