DIASTOLIC BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH SEVERE AKI AFTER ACUTE ISCHEMIC STROKE

 

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DIASTOLIC BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH SEVERE AKI AFTER ACUTE ISCHEMIC STROKE

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Won Hee
Cho
Won Hee Cho minime12@naver.com Veterans Health Service Medical Center Department of Nephrology Seoul Korea (Republic of) *
Young Lee lyou7688@bohun.or.kr Veterans Health Service Medical Center Veterans Medical Research Institute Seoul Korea (Republic of) -
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In acute ischemic stroke (AIS)—particularly among patients admitted to intensive care—the risk of acute kidney injury (AKI) is high. Although blood pressure variability (BPV) has been associated with adverse outcomes and independently predicts incident AKI in general populations, evidence directly relating acute‑phase BPV to AKI after cerebral infarction remains limited.

We analyzed 2,415 hospitalized AIS patients. Exposures were Variation Independent of the Mean (VIM)‑based BPV for diastolic (DBP) and systolic (SBP) blood pressure. Outcomes were in‑hospital AKI (KDIGO 1–3) and severe AKI (KDIGO 2–3). We prespecified four multiple logistic regression models: Model 1 (BPV only), Model 2 (+ age, sex, baseline kidney function as CKD grade, mean BP), Model 3 (+ heart failure, diabetes, hypertension), and Model 4 (+ NIHSS).

Incidence was 2.9% (70/2,415) for any AKI and 1.37% (33/2,415) for AKI 2–3. Across DBP‑VIM quartiles, AKI rates increased from 1.3% to 4.6% for any AKI (p=0.005) and from 0.5% to 2.5% for AKI 2–3 (p=0.027); higher NIHSS categories were also more frequent with higher DBP‑VIM (p<0.001). After multivariable adjustment, DBP VIM remained associated with severe AKI even after NIHSS (Model 4 OR 1.308; 95% CI 1.003–1.707; p=0.048). In contrast, its association with any AKI was attenuated (OR 1.109; p=0.313), and SBP VIM was not significant for either outcome in Model 4 (AKI p=0.263; AKI 2–3 p=0.674).

In AIS, diastolic BP variability (DBP VIM) shows a residual association with severe AKI after adjustment for clinical severity (NIHSS), whereas its association with any AKI appears largely explained by severity. Systolic BP variability was not independently associated with AKI after full adjustment.

Kewords