renal continuum in older patients after acute cerebrovascular accident

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Abstract Title *

renal continuum in older patients after acute cerebrovascular accident

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Co-author 1

Mariya Rebrovskaya rebrovskayamary@mail.ru Ulyanovsk State University Department of Therapy and Occupational Diseases Ulyanovsk Russia -

Co-author 2

Elena Efremova lena_1953@mail.ru Ulyanovsk State University Department of Therapy and Occupational Diseases Ulyanovsk Russia *

Co-author 3

Alexander Shutov amshu@mail.ru Ulyanovsk State University Department of Therapy and Occupational Diseases Ulyanovsk Russia -

Co-author 4

Timur Bakher Tay.baher@hotmail.com First Pavlov State Medical University of St. Petersburg Faculty of internal medicine St.Petersburg Russia -

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Introduction

Among patients with acute cerebrovascular accidents (CVA) the prevalence of nephrological pathology is quite high and requires increased attention, especially in the older population. The presence of renal dysfunction is associated with more unfavorable prognosis and low opportunities for post-stroke rehabilitation. The aim of the study – to assess the value of renal dysfunction for patients in the older group after suffering an acute cerebrovascular accident.

Methods

Prospective cohort study includes 130 patients (71 men, mean age 68.6 ± 6.5 years) who suffered CVA (stroke) less than 6 months ago. Patients have early recovery rehabilitation. Levels of proinflammatory interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin 18 (IL-18), vascular endothelial growth factor (VEGF), monocytic chemotactic protein-1 (MCP-1), erythropoietin, anti-inflammatory interleukin 10 (IL-10) were evaluated. An analysis of medical records was conducted during the patients' hospital staying for the treatment of CVA. There were determined the prevalence of acute kidney injury (AKI), chronic kidney disease (CKD), and AKI phenotypes were determined in this population group. KDIGO (2012, 2024) were used to diagnose AKI, CKD. Differences at p <0.05 were considered as significant.

Results

AKI was detected in 45 (34.6%) patients, mainly stage 1 - in 42 (93.3%). At the time of admission to the hospital for stroke, 58 patients (44.6%) had CKD. CKD-related AKI was detected in 21 patients (16,2%). Prehospital AKI was established in 29 (64.4%), hospital AKI - in 16 patients (35.5%). A decrease in eGFR ≤ 60 mL/min/1.73 m2 had 66 patients (50.8%) in the rehabilitation department. High levels of proinflammatory IL-6, IL-8, IL-18, VEGF and MCP-1, low levels of anti-inflammatory IL-10 and erythropoietin were detected in older patients after CVA with renal dysfunction (p <0.05) (Table 1,2)

Parameter N=96, Me (IQR)

IL-6 (Me (IQR), pg/ml 2,7 (2,1;4,8)

IL-8 (Me (IQR), pg/ml 9,5 (5,7;18,9)

IL-10 (Me (IQR), pg/ml 1,5 (0,2;6,8)

IL-18 (Me (IQR), pg/ml 106,9 (59,4;210,5)

MCP1 (Me (IQR), pg/ml 329,8 (149,5;465,3)

VEGF (Me (IQR), pg/ml 200,2 (126,1;323,9)

Erythropoetin (Me (IQR), mME/ml 11,5 (7,6;16,9)

Table 1. Proinflammatory profile of patients serum

Parameter N=96, Me (IQR)

IL-6 (Me (IQR), pg/ml 3,5 (1,0;10,7)

IL-8 (Me (IQR), pg/ml 1,9 (0,0;10,9)

IL-10 (Me (IQR), pg/ml 0,0 (0,0;1,1)

IL-18 (Me (IQR), pg/ml 0,1 (0,0;6,22)

MCP1 (Me (IQR), pg/ml 61,3 (5,9;216,2)

VEGF (Me (IQR), pg/ml 46,6 (12,3;182,5)

Table 2. Proinflammatory profile of patients urine

Conclusion

Every second older patients who suffered CVA have the CKD. AKI was observed in 16,2% older patients with stroke. In the early rehabilitation period, an increase in pro-inflammatory cytokines was observed in older patients with CKD.

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