To study the relationship of chronic kidney disease (CKD) and renal replacement therapy (RRT) on hematoma expansion (HE), perihematomal edema (PHE) expansion and patient outcomes following intracranial hemorrhage (ICH).

Thirty million Americans live with CKD and are at risk for cerebral ICH. CKD related uremia is associated with dysfunctions in hemostasis and an osmotic disequilibrium syndrome particularly with rapid urea clearance. In this study, we tested the hypothesis that CKD with or without RRT is associated with a higher frequency of HE and PHE.

The Get with the guideline-Stroke database was queried for all patients admitted with spontaneous ICH (n=734). We identified patients with CKD defined as glomerula filtration rate <30 mL/min/1.73 m² and RRT within 36h of admission. ABC/2 formula was used to measure hemtoma and PHE volumes. Secondary causes, brainstem ICH and <7cc of hematoma were excluded. CKD patients were matched to control group by sex, age, ICH location and hematoma volume. Medical records were examined for potential confounders. Outcome measures were HE, PHE at 24h and post-HD, and discharge disposition. The Wilcoxon signed rank test was used to identify significant differences in outcomes.

Clinical and demographic characteristics did not differ between the matched groups. CKD patients with or without RRT had larger HE at 24h compared to the control group (28cc and 33cc vs 22cc; p<0.05). Both, initial and 24h PHE were  strongly associated with RRT compared with control (37cc and 45cc vs 13cc and 16cc; p<<0.05). PHE did not differ significantly between patients without RRT and controls. Moreover, patients with RRT had the worst outcomes (0% self-care disposition vs 12% in CKD and 25% in control, p<0.05).

In CKD patients with ICH, RRT was strongly associated with PHE expansion and worse patient outcomes. Further studies are needed to understand the role of RRT in ICH pathogenesis.