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제목	Early Diastolic Blood Pressure Variability is Associated with Moderate-to-Severe Acute Kidney Injury After Acute Ischemic Stroke
저자	Won Hee Cho
출판정보	2026; 2026(1):
키워드	Acute ischemic stroke, Acute kidney injury, Blood pressure variability, Diastolic blood pressure, Hemodynamics
초록	Objectives: Acute kidney injury (AKI) is a serious complication after acute ischemic stroke (AIS), associated with poor outcomes. While blood pressure variability (BPV) is a known risk factor for kidney function decline in chronic settings, its impact on AKI during the acute phase of stroke remains unclear. We aimed to investigate whether early diastolic blood pressure (DBP) variability during hospitalization predicts the incidence and severity of AKI in AIS patients. Methods: We conducted a retrospective cohort study of 2,421 adults admitted with AIS to the Veterans Health Service Medical Center. DBP variability was quantified as the coefficient of variation of DBP (DBP-CV) using measurements from the first 72 hours. Outcomes were any AKI (Kidney Disease: Improving Global Outcomes [KDIGO] stage 1–3) and moderate-to-severe AKI (KDIGO stage 2–3) defined by creatinine criteria. Multivariable logistic regression adjusted for age, sex, baseline estimated glomerular filtration rate (eGFR), mean DBP, comorbidities, and stroke severity (National Institutes of Health Stroke Scale score). Results: AKI occurred in 70 patients (2.9%), including 33 (1.4%) with KDIGO stage 2–3. DBP-CV was independently associated with stage 2–3 AKI (adjusted odds ratio 1.95 per 0.1-unit increase; 95% confidence interval 1.07–3.56; p=0.028) but not with any AKI (adjusted odds ratio 1.41; 95% confidence interval 0.91–2.18; p=0.128). The highest versus lowest DBP-CV quartile was associated with stage 2–3 AKI (adjusted odds ratio 4.30; 95% confidence interval 1.13–16.31; p=0.032). The association with stage 2–3 AKI was stronger in patients <75 years (odds ratio 6.30; p for interaction=0.002) and in those with baseline eGFR ≥60 mL/min/1.73 m² (odds ratio 3.01; p for interaction=0.054). Conclusion: Early DBP variability after AIS is independently associated with moderate-to-severe AKI, particularly in younger patients and those with preserved baseline kidney function. DBP variability may represent a modifiable hemodynamic risk factor for severe AKI after AIS.
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