Abstract
Background Patients hospitalized with acute stroke are at risk of developing acute kidney injury (AKI), and when both conditions occur together, patient outcomes are often worse. The relationship between stroke type, patient characteristics, and the development of AKI is not fully understood, particularly in tertiary care settings in Pakistan, where healthcare resources and patient characteristics may differ from Western populations. Objective To determine the frequency of AKI and identify associated risk factors, including stroke type, severity, and comorbidities, in patients presenting with acute stroke at a tertiary care center in Pakistan, the Hayatabad Medical Complex, Peshawar. Methods This cross-sectional study was conducted at Hayatabad Medical Complex, Peshawar, from February to July 2023. A total of 214 patients with acute stroke were enrolled through non-probability consecutive sampling. AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria as an increase in serum creatinine by ≥0.3 mg/dL within 48 hours or ≥1.5 times baseline within seven days. Chi-square tests and multivariate logistic regression were used for statistical analysis using IBM SPSS Statistics, Version 23 (IBM Corp., Armonk, NY, USA). Results Among 214 stroke patients (mean age 53.08±7.52 years, 59.8% male), AKI occurred in 33 patients (15.4%, 95% CI: 10.8-20.9). Ischemic strokes (n=147, 68.7%) showed lower AKI prevalence compared to hemorrhagic strokes (10.2% vs 26.9%, p<0.005). AKI occurred in all severe stroke cases (26/26, 100%) but none in mild (0/12) or moderate (0/149) cases (p<0.001). Comorbidity distribution showed isolated hypertension in 9.3%, diabetes in 38.3%, and both conditions in 52.3% of patients. Mean baseline creatinine was 0.98±0.24 mg/dL, with peak levels of 1.42±0.38 mg/dL in the AKI group. Conclusions In our tertiary care setting, AKI occurred in 15.4% of acute stroke patients, with significantly higher rates of hemorrhagic strokes and severe cases. While hypertension and diabetes were common comorbidities, stroke type and severity were stronger predictors of AKI development. These findings suggest the need for targeted monitoring strategies, particularly in patients with hemorrhagic or severe strokes, to facilitate early detection and management of AKI in acute stroke settings.