title: Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage.
abstract: BACKGROUND
  The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain.
  
  
  METHODS
  Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP<140mmHg) or contemporaneous guideline-based (target SBP<180mmHg) BP management.
  
  
  METHODS
  2,823 patients from 144 clinical hospitals in 21 countries.
  
  
  METHODS
  Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (>90, 60-90, and <60mL/min/1.73m(2), respectively).
  
  
  RESULTS
  The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms.
  
  
  RESULTS
  Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P=0.5 for homogeneity).
  
  
  CONCLUSIONS
  Generalizability issues arising from a clinical trial population.
  
  
  CONCLUSIONS
  Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs.
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Danni
authors.initials: D
authors.lastname: Zheng
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Department of Neurology, The Second Affiliated Hospital of Suzhou University, Suzhou, China.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Cao
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents
keywords: INTERACT2; Kidney function; cerebral hemorrhage; cerebrovascular disease; chronic kidney disease (CKD); dialysis; estimated glomerular filtration rate (eGFR); hemodialysis; intensive blood pressure lowering treatment; intracerebral hemorrhage (ICH); stroke; systolic blood pressure