title: Hospitalized hemorrhagic stroke patients with renal insufficiency: clinical characteristics, care patterns, and outcomes.
abstract: BACKGROUND
  There is a paucity of information on clinical characteristics, care patterns, and clinical outcomes for hospitalized intracerebral hemorrhage (ICH) patients with chronic kidney disease (CKD). We assessed characteristics, care processes, and in-hospital outcome among ICH patients with CKD in the Get With the Guidelines-Stroke (GWTG-Stroke) program.
  
  
  METHODS
  We analyzed 113,059 ICH patients hospitalized at 1472 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. In-hospital mortality and use of 2 predefined ICH performance measures were examined based on glomerular filtration rate. Renal dysfunction was categorized as a dichotomous (+CKD = estimated glomerular filtration rate <60) or rank ordered variable as CKD (<60), and by clinical stage: (normal [≥90], mild [≥60-<90], moderate [≥30-<60], severe [≥15-<30], and/or kidney failure [<15 or dialysis]).
  
  
  RESULTS
  There were 33,219 (29%) ICH patients with CKD. Patients with CKD were more likely to be older, female, and with comorbid conditions such as diabetes. Compared with patients with normal kidney function, those with CKD were slightly less likely to receive deep venous thrombosis (DVT) prophylaxis but similarly received discharge smoking cessation intervention. Inpatient mortality was also higher for those with CKD (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.42-1.52), mild dysfunction (adjusted OR, 1.12; 95% CI, 1.08-1.16), moderate dysfunction (adjusted OR, 1.46; 95% CI, 1.39-1.53), severe dysfunction (adjusted OR, 1.96; 95% CI, 1.81-2.12), and kidney failure (adjusted OR, 2.22; 95% CI, 2.04-2.43) relative to those with normal renal function.
  
  
  CONCLUSIONS
  Chronic kidney disease is present in nearly a third of patients hospitalized with ICH and is associated with slightly worse care and substantially higher mortality than those with normal renal function.
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina. Electronic address: ovibes@musc.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Division of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.affiliation: Stroke Center and Department of Neurology, University of California, Los Angeles, California.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Division of Cardiology, University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000401:mortality / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease; glomerular filtration rate; guidelines; hemorrhagic stroke; outcomes; prognosis; quality indicators; renal