Acute Kidney Injury After Intensive Blood Pressure Lowering Following Successful Endovascular Thrombectomy

BACKGROUND: The effect of postthrombectomy blood pressure (BP) management on the development of acute kidney injury (AKI) in patients with acute ischemic stroke remains largely unexplored. METHODS: This secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control) included patients with acute ischemic stroke due to large-vessel occlusion who achieved successful endovascular thrombectomy and had a systolic BP ≥140 mm Hg. Patients were randomized to intensive (target systolic BP <140 mm Hg) or conventional (target systolic BP 140-180 mm Hg) BP management for 24 hours. The outcomes were AKI within 7 days and within 2 days, defined according to the Kidney Disease: Improving Global Outcomes criteria. In addition, we examined the associations between AKI and functional independence at 3 months, defined as a modified Rankin Scale score of 0 to 2. Multivariable logistic regression analyses were performed with adjustment for age, sex, time from stroke onset to enrollment, baseline National Institutes of Health Stroke Scale score, and baseline estimated glomerular filtration rate. RESULTS: Of 306 patients, 19 were excluded, and 287 patients were included in this analysis (mean age, 73.2 years; 117 [40.8%] women). AKI within 7 days occurred more frequently in the intensive management group than in the conventional group (20/147 [13.6%] versus 9/140 [6.4%]; adjusted odds ratio, 2.54 [95% CI, 1.10-6.35]). Most AKI events were stage 1 (20/29 [69.0%]). Early AKI within 2 days was also more common with intensive BP management. Patients with AKI had significantly lower rates of functional independence (4/29 [13.8%] versus 126/257 [49.0%]; adjusted odds ratio, 0.19 [95% CI, 0.05-0.55]) and higher stroke-related mortality at 3 months (11/29 [37.9%] versus 8/257 [3.1%]; adjusted odds ratio, 13.8 [95% CI, 4.14-49.64]). In a sensitivity analysis with equal creatinine ascertainment, the association with 48-hour AKI did not reach statistical significance (7/76 [9.2%] versus 2/66 [3.0%]; adjusted odds ratio, 4.20 [95% CI, 0.83-32.6]), although the absolute risk difference remained directionally consistent. CONCLUSIONS: Intensive BP lowering after successful endovascular thrombectomy was associated with a higher risk of AKI, even when kidney injury was predominantly mild. In addition, AKI was associated with worse neurological outcomes. These findings suggest that AKI is an important marker of systemic hemodynamic vulnerability after aggressive postendovascular thrombectomy BP lowering. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04205305.

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Journal
Stroke
Published
2026-07-24
DOI
https://doi.org/10.1161/strokeaha.126.056127
Primary Topic
Acute Kidney Injury Research
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article
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article

Acute Kidney Injury After Intensive Blood Pressure Lowering Following Successful Endovascular Thrombectomy

JoonNyung Heo, Jang‐Hyun Baek, Ji Hoe Heo, Young Dae Kim et al.
Stroke
Acute Kidney Injury Research
article

Acute Kidney Injury After Intensive Blood Pressure Lowering Following Successful Endovascular Thrombectomy

JoonNyung Heo, Jang‐Hyun Baek, Ji Hoe Heo, Young Dae Kim, Seong Hwan Ahn, Byung Moon Kim, Yo Han Jung, Sungwook Yu, Yoonkyung Chang, Jae Wook Jung, Hee Byung Koh, Kwon Sh, Hye Sun Lee, Jun Young Chang, Jinkwon Kim, Hyo Suk Nam, Jeong‐Ho Hong, Soyoung Jeon, Taedong Ok, Oh Young Bang, Sang Hee Ha, Chi Kyung Kim, Han‐Jin Cho, Joonsang Yoo, Na‐Young Shin, Kwon–Duk Seo, Sukyoon Lee, Sung‐Il Sohn, Gyu Sik Kim, Tae‐Jin Song, Hyungjong Park, Minyoul Baik, Yang‐Ha Hwang, Dong Joon Kim, Jung Hwa Seo, Jae Guk Kim, Jaeseob Yun, J H Choi, for the OPTIMAL-BP Trial Investigators, Dong Hoon Shin, Kwang Hyun Kim, Hyungwoo Lee, Il Hyung Lee
article en

Abstract

BACKGROUND: The effect of postthrombectomy blood pressure (BP) management on the development of acute kidney injury (AKI) in patients with acute ischemic stroke remains largely unexplored. METHODS: This secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control) included patients with acute ischemic stroke due to large-vessel occlusion who achieved successful endovascular thrombectomy and had a systolic BP ≥140 mm Hg. Patients were randomized to intensive (target systolic BP <140 mm Hg) or conventional (target systolic BP 140-180 mm Hg) BP management for 24 hours. The outcomes were AKI within 7 days and within 2 days, defined according to the Kidney Disease: Improving Global Outcomes criteria. In addition, we examined the associations between AKI and functional independence at 3 months, defined as a modified Rankin Scale score of 0 to 2. Multivariable logistic regression analyses were performed with adjustment for age, sex, time from stroke onset to enrollment, baseline National Institutes of Health Stroke Scale score, and baseline estimated glomerular filtration rate. RESULTS: Of 306 patients, 19 were excluded, and 287 patients were included in this analysis (mean age, 73.2 years; 117 [40.8%] women). AKI within 7 days occurred more frequently in the intensive management group than in the conventional group (20/147 [13.6%] versus 9/140 [6.4%]; adjusted odds ratio, 2.54 [95% CI, 1.10-6.35]). Most AKI events were stage 1 (20/29 [69.0%]). Early AKI within 2 days was also more common with intensive BP management. Patients with AKI had significantly lower rates of functional independence (4/29 [13.8%] versus 126/257 [49.0%]; adjusted odds ratio, 0.19 [95% CI, 0.05-0.55]) and higher stroke-related mortality at 3 months (11/29 [37.9%] versus 8/257 [3.1%]; adjusted odds ratio, 13.8 [95% CI, 4.14-49.64]). In a sensitivity analysis with equal creatinine ascertainment, the association with 48-hour AKI did not reach statistical significance (7/76 [9.2%] versus 2/66 [3.0%]; adjusted odds ratio, 4.20 [95% CI, 0.83-32.6]), although the absolute risk difference remained directionally consistent. CONCLUSIONS: Intensive BP lowering after successful endovascular thrombectomy was associated with a higher risk of AKI, even when kidney injury was predominantly mild. In addition, AKI was associated with worse neurological outcomes. These findings suggest that AKI is an important marker of systemic hemodynamic vulnerability after aggressive postendovascular thrombectomy BP lowering. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04205305.

Stroke
Ewha Womans University (KR), Chosun University (KR), Yonsei University (KR), Eulji University (KR), Severance Hospital (KR), Korea University Medical Center (KR), Dong-A University Hospital (KR), Kyungpook National University Hospital (KR), Samsung Medical Center (KR), University of Ulsan (KR), Seoul Medical Center (KR), Gachon University Gil Medical Center (KR), Kangbuk Samsung Hospital (KR), Inje University Busan Paik Hospital (KR), CHA University Bundang Medical Center (KR), Gangnam Severance Hospital (KR), Kyung Hee University Hospital at Gangdong (KR), National Health Insurance Service (KR), Korea University (JP), Kyungpook National University Chilgok Hospital (KR), Keimyung University Dongsan Hospital (KR), Pusan National University (KR), Keimyung University (KR)
Good health and well-being
Openalex Percentile: Top 9%
Acute Kidney Injury Research
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