# One-Year Renal Recovery Following Acute Kidney Injury in Stroke Patients: A Prospective Longitudinal Follow-Up Study From Hayatabad Medical Complex Peshawar

## TL;DR

Most stroke patients with acute kidney injury recover kidney function within a year, even in resource-limited settings like Pakistan.

## Contribution

This study provides the first prospective longitudinal data on one-year renal recovery in stroke-associated AKI in a resource-limited setting.

## Key findings

- 77.4% of stroke patients with AKI achieved complete renal recovery within one year without intervention.
- Patients with severe stroke had slower recovery compared to those with moderate-to-severe stroke.
- Lower peak creatinine, younger age, and moderate-to-severe stroke predicted faster recovery.

## Abstract

Background and aim

Acute kidney injury (AKI) significantly affects stroke patients, yet long-term recovery patterns remain poorly understood, especially in resource-limited settings. The incidence of AKI in stroke patients is notable, particularly in severe cases, but it is unclear whether these injuries are permanent or reversible; a critical knowledge gap for patient counseling, resource allocation, and healthcare planning where dialysis is limited. This prospective longitudinal follow-up study assessed one-year renal recovery outcomes in stroke-associated AKI, examining recovery patterns, temporal trajectories, and influencing factors.

Methods

This prospective longitudinal follow-up study tracked 33 stroke patients who developed AKI from an original cohort of 214 patients over 12 months (August 2023 to August 2024). Renal function was assessed every three months using serum creatinine and estimated glomerular filtration rate (eGFR). Complete recovery was defined as a return to baseline creatinine ±0.2 mg/dL or an eGFR >60 mL/min/1.73 m².

Results

Of the 33 patients with AKI, 31 (93.9%) completed the 12-month follow-up. Among survivors, 24/31 (77.4%) achieved complete renal recovery without intervention, while 7/31 (22.6%) had persistent mild dysfunction. Two patients died at three months with persistent dysfunction, yielding a population-level recovery rate of 72.7% (24/33) when accounting for early mortality. No patients required dialysis per the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Patients with hemorrhagic stroke showed recovery rates comparable to those with ischemic stroke (83.3% vs. 69.2%, p = 0.543). Patients with severe stroke had slower recovery (median 8.2 months vs. 5.1 months for moderate-to-severe cases, p = 0.041). Predictors of faster recovery included lower peak creatinine (HR, 2.63 per mg/dL decrease; 95% CI, 1.31-5.26; p = 0.006), moderate-to-severe versus severe stroke (HR, 1.89; 95% CI, 1.12-3.18; p = 0.017), and younger age (HR, 1.12 per year decrease; 95% CI, 1.02-1.23; p = 0.021).

Conclusions

Most stroke-related AKI demonstrates excellent spontaneous recovery within one year, supporting conservative management approaches in similar patients. Even patients with severe strokes and multiple comorbidities showed robust long-term renal recovery in Pakistani healthcare settings. However, these findings should be confirmed in larger multicenter studies, given the small sample size and potential survival bias due to early mortality.