Posterior Reversible Encephalopathy Syndrome in CKD: A Comprehensive National Analysis, 2016-2019

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is an acute clinical-radiographic neurological syndrome that is potentially reversible with timely treatment. However, if untreated, it may result in severe complications such as intracerebral hemorrhage (ICH). Patients with kidney disease are at an increased risk of developing PRES. It remains unclear whether this is due to concurrent conditions such as hypertension and autoimmune disorders or if renal dysfunction itself is an independent risk factor. Furthermore, the impact of kidney function on the outcomes of PRES is still uncertain. This study aimed to examine the incidence and outcomes of PRES across various stages of chronic kidney disease (CKD), compared to a kidney disease-free group (NKD). Methods: We conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) database to identify adult patients non-electively admitted with PRES from 2016 to 2019, categorizing them into CKD stages 3, 4, 5; end-stage kidney disease (ESKD); NKD; and an Others group. Results: The study included 12,605 patients, representing 0.014% of all admissions. PRES hospitalizations increased significantly from 2016 to 2019. (trend p=0.012). The cohort had a mean age of 57.5 years, with 71.5% female and 72.5% White. Patients with CKD had higher PRES incidence in a dose-response manner as CKD stages advanced from 3 to ESKD. Key risk factors for PRES included gender, hypertension, metastasis, drug use, history of solid organ transplant, carotid artery stenosis, cerebral atherosclerosis, migraine, SLE, and systemic sclerosis. ESKD patients had significantly higher in-hospital mortality (aOR 4.61, 95% CI 1.84-11.57, p= 0.001). Differences in ICH and stroke rates across CKD stages/ESKD and NKD were not statistically significant. Conclusion: Our findings provide valuable insights into the impact of CKD on the incidence and outcomes of PRES. Our study establishes an association between CKD and PRES, demonstrating a dose-response relationship. ESKD is an independent risk factor for in-hospital mortality. Given these insights, our study emphasizes the need for heightened awareness and targeted management strategies to improve outcomes for this vulnerable group. It also calls for further research to explore the specific mechanisms linking CKD and PRES.