title: Chronic kidney disease in patients with acute intracerebral hemorrhage: association with large hematoma volume and poor outcome.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is associated with both a risk of adverse vascular outcome and a risk of bleeding. We have tested the hypothesis that in the setting of an acute intracerebral hemorrhage (ICH), CKD is associated with poor outcome and with larger hematoma volume.
  
  
  METHODS
  We examined the association between CKD and ICH characteristics and outcome within a prospective cohort study of consecutive patients hospitalized with an acute stroke and followed for 1 year. CKD was categorized by the estimated baseline glomerular filtration rate into moderate/severe impairment (<45), mild impairment (45-60) and no impairment (>60 ml/min/1.73 m(2)).
  
  
  RESULTS
  Among 128 patients with an ICH (mean age = 71.7 ± 12.3 years, 41.4% women) 46.1% had CKD (23.4% mild and 22.7% moderate/severe). Patients with moderate/severe impairment had >4-fold adjusted hazard ratio for mortality over 1 year (4.29; 95% CI = 1.69-10.90) compared to patients with no impairment. The hematoma volumes [median (25-75%)] were 15.3 ml (5.4-37.5) in patients with no impairment, 16.6 (6.8-36.9) in mild impairment and 50.2 (10.4-109.1) in moderate/severe impairment (p = 0.009). The location of the hematoma was lobar in 12% with no impairment, 17% with mild impairment and 39% with moderate/severe impairment (p = 0.02). Patients with moderate/severe impairment exhibited a 2.3-fold higher hematoma volume (p = 0.04) and a >6-fold higher odds of lobar location (95% CI = 1.59-24.02) as compared to no impairment. Further adjustment for antiplatelet use and for presence of leukoaraiosis attenuated the association with hematoma volume (p = 0.15), while moderate/severe impairment was associated with an adjusted OR of 5.35 (95% CI = 1.18-24.14) for lobar location.
  
  
  CONCLUSIONS
  Presence of moderate/severe CKD among patients with ICH is associated with larger, lobar hematomas and with poor outcome.
authors.affiliation: Stroke Center, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Molshatzki
authors.forename: David
authors.initials: D
authors.lastname: Orion
authors.forename: Rakefet
authors.initials: R
authors.lastname: Tsabari
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schwammenthal
authors.forename: Oleg
authors.initials: O
authors.lastname: Merzeliak
authors.forename: Maya
authors.initials: M
authors.lastname: Toashi
authors.forename: David
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed