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Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease: Incidence, Outcomes, and Risk Factors in a National Cohort

Year: 2025

Type: article

Abstract: Rationale & Objective Posterior Reversible Encephalopathy Syndrome (PRES) is an acute neurological condition that, if untreated, can result in severe complications such as intracerebral haemorrhage (ICH). Patients with CKD are at an increased risk of developing PRES; however, it is unclear whether this risk is primarily driven by comorbidities or if renal dysfunction itself is an independent risk factor. This study aimed to evaluate the incidence, outcomes, and resource utilization of PRES across CKD stages compared to patients without kidney disease (NKD). Study Design Retrospective study using the Nationwide inpatient sample database. Setting & Participants Adult patients non-electively admitted with PRES from 2016 to 2019. Exposures Different stages of CKD versus no kidney disease Outcomes All-cause in-hospital mortality, Incidence of PRES hospitalizations, in-hospital morbidity (ICH, ischemic stroke, brain herniation, status epilepticus), healthcare resource utilization (length of hospital stay (LOS) and total hospitalization charges (THC)) Analytical Approach Multivariate logistic and linear regression analyses were conducted using survey design methods Results The cohort included 12,605 patients, representing 0.014% of all admissions. PRES incidence increased from 0.013% in 2016 to 0.015% in 2019 (p = 0.01) and demonstrated a dose-response relationship with CKD stage progression. Key risk factors for PRES included female sex, White race, hypertension, metastatic cancer, solid organ transplantation, rheumatologic disorders, substance use disorders, carotid artery stenosis, migraines, and cerebral atherosclerosis. . Kidney failure (KF) was strongly associated with in-hospital mortality (aOR 5.12, 95% CI 2.09–12.53, p < 0.001). LOS, THC, and rates of neurological complications were similar between CKD/KF and NKD patients. Limitations The use of administrative data limits access to detailed clinical information . Residual confounding factors remain possible. Conclusions This is the largest study to date on PRES in CKD populations. CKD is strongly associated with PRES, with a dose-response relationship, and KF is an independent risk factor for in-hospital mortality, emphasizing the need for heightened clinical vigilance in this population.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2025.101022

Authors: Mingyue He, Avrum Gillespie

Institutions: Temple University Hospital, Temple University Health System, Temple University

Language: English

Topic: Neurological Complications and Syndromes

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,590