The edition · Nephrology
Intensive blood pressure lowering after thrombectomy doubled acute kidney injury, and AKI marked far worse neurological outcomes
In 287 patients after successful endovascular thrombectomy, intensive blood pressure management raised seven-day AKI from 6.4% to 13.6%. Most injury was stage 1, yet patients who sustained it achieved functional independence in 13.8% against 49.0%, and died from stroke in 37.9% against 3.1%.
The edition in brief
The finding worth carrying today sits at the boundary between two specialties, which is where it has been overlooked. In 287 patients after successful endovascular thrombectomy for stroke, intensive blood pressure lowering was associated with acute kidney injury within seven days in 13.6% against 6.4% with conventional management, an adjusted odds ratio of 2.54. Sixty-nine per cent of that injury was stage 1 — the mildest category, the kind routinely recorded and disregarded. It should not be disregarded. Patients who developed AKI achieved functional independence at three months in 4 of 29 cases (13.8%) against 126 of 257 (49.0%), and stroke-related mortality was 37.9% against 3.1%, an adjusted odds ratio of 13.8. The authors' interpretation is the careful one: AKI here is most plausibly a marker of systemic haemodynamic vulnerability rather than a cause of the neurological outcome. A sensitivity analysis equalising creatinine ascertainment weakened the association to non-significance while keeping its direction, which matters — patients managed intensively had their creatinine checked more often. Elsewhere: SGLT2 inhibitors in autosomal dominant polycystic kidney disease showed no convincing kidney benefit across six studies and 451 patients, and a twelve-week structured exercise programme increased vascular access vessel diameter by 0.9 mm against 0.1 mm in haemodialysis patients.
Intensive blood pressure lowering after thrombectomy raised AKI, and AKI flagged much worse outcomes
Intensive blood pressure lowering after successful thrombectomy doubled seven-day acute kidney injury, and patients who developed even stage 1 AKI had markedly worse functional and mortality outcomes.
SGLT2 inhibitors have not been shown to help in polycystic kidney disease
SGLT2 inhibitors have not been shown to slow eGFR decline or kidney growth in autosomal dominant polycystic kidney disease, on six mostly observational studies totalling 451 patients.
Twelve weeks of structured exercise widened vascular access vessels
A twelve-week structured exercise programme increased vascular access vessel diameter by 0.9 mm against 0.1 mm in haemodialysis patients, alongside better walking distance, mood and quality of life.
No new regulatory action; KDIGO reports on B-cell targeting in immune kidney disease
KDIGO has published conclusions from a Controversies Conference on B-cell targeting in immune-mediated kidney disease, mapping what is agreed and disputed rather than issuing graded recommendations.
Ask who was monitored more closely before believing a complication rate
For any complication defined by a laboratory value rather than an event, ask whether both groups were tested equally often — unequal monitoring inflates the rate in the more closely watched arm.
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