- •This study aims to evaluate the short-term (1-month) and long-term (1-year) mortality for patients with acute ischemic stroke by the glomerular filtration rate (eGFR) levels measured at admission: ≥ 90, 60–89, 30–59, 15–29, and <15 mL/min/1.73 m2 or on dialysis.
- •Patients with reduced eGFR were at higher risk of dying either at short- or long-term in a graded relationship.
Background and aims
Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke.
From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and <15 mL/min/1.73 m2 or on dialysis. Risks of 1-month mortality and 1-year mortality after ischemic stroke were investigated by the eGFR level.
Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR <15 mL/min/1.73 m2 or dialysis than in patients with eGFR ≥90 mL/min/1.73 m2 (2.88 versus 0.56 per 1000 person-days). The adjusted hazard ratio (HR) of 1-month mortality increased from 1.31 (95% CI = 1.08–1.59) for patients with eGFR 60–89 mL/min/1.73 m2 to 2.33 (95% CI = 1.80–3.02) for patients with eGFR < 15 mL/min/1.73 m2 or on dialysis. 3226 patients died within one year. The adjusted HR of mortality increased from 1.38 (95% CI = 1.21–1.59) for patients with eGFR 60–89 mL/min/1.73 m2 to 2.60 (95% CI 2.18–3.10) for patients with eGFR < 15 mL/min/1.73 m2 or on dialysis, compared to patients with eGFR ≥ 90 mL/min/1.73 m2.
After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.
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- Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study.Lancet. 2016; 388: 761-775
- Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.N. Engl. J. Med. 2004; 351: 1296-1305
- Impact of kidney disease and blood pressure on the development of cardiovascular disease: an overview from the Japan Arteriosclerosis Longitudinal Study.Circulation. 2008; 118: 2694-2701
- CKD and cardiovascular disease in screened high-risk volunteer and general populations: the kidney early evaluation program (KEEP) and national health and nutrition examination survey (NHANES) 1999-2004.Am. J. Kidney Dis. 2008; 51: S38-S45
- Prevalence of kidney damage in Australian adults: the AusDiab kidney study.J. Am. Soc. Nephrol. 2003; 14: S131-S138
- Prevalence of chronic kidney disease and decreased kidney function in the adult US population: third National Health and Nutrition Examination Survey.Am. J. Kidney Dis. 2003; 41: 1-12
- All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan.Lancet. 2008; 371: 2173-2182
- US renal data system 2012 annual data report.Am. J. Kidney Dis. 2013; 61 (e1–476): A7
- Renal dysfunction is associated with poststroke discharge disposition and in-hospital mortality: findings from Get with the guidelines-stroke.Stroke. 2017; 48: 327-334
- Association between renal function and clinical outcome in patients with acute stroke.Eur. Neurol. 2010; 63: 237-242
- Proteinuria and clinical outcomes after ischemic stroke.Neurology. 2012; 78: 1909-1915
- Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study.Stroke. 2002; 33: 1630-1635
- Indices of kidney dysfunction and discharge outcomes in hospitalized stroke patients without known renal disease.Cerebrovasc. Dis. 2009; 28: 582-588
- Chronic kidney disease and clinical outcome in patients with acute stroke.Stroke. 2009; 40: 1296-1303
- Renal dysfunction and chronic kidney disease in ischemic stroke and transient ischemic attack: a population-based study.Int. J. Stroke. 2017; 12: 761-769
- Relationship between kidney dysfunction and ischemic stroke outcomes: albuminuria, but not estimated glomerular filtration rate, is associated with the risk of further vascular events and mortality after stroke.PLoS One. 2016; 11e0155939
- A prospective study about impact of renal dysfunction and morbidity and mortality on cardiovascular events after ischemic stroke.Cardiol. J. 2014; 21: 163-169
- Get with the guidelines-stroke performance indicators: surveillance of stroke care in the taiwan stroke registry: Get with the guidelines-stroke in taiwan.Circulation. 2010; 122: 1116-1123
- Clinical practice. Transient ischemic attack.N. Engl. J. Med. 2002; 347: 1687-1692
- A new equation to estimate glomerular filtration rate.Ann. Intern Med. 2009; 150: 604-612
- Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population.Am. J. Epidemiol. 2008; 167: 1226-1234
- Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction.N. Engl. J. Med. 2004; 351: 1285-1295
- Renal function as a predictor of outcome in a broad spectrum of patients with heart failure.Circulation. 2006; 113: 671-678
- Prevalence and impact of renal insufficiency on clinical outcomes of patients undergoing coronary revascularization.Circ. J. 2007; 71: 1299-1304
- Low estimated glomerular filtration rate is associated with poor outcomes in patients who suffered a large artery atherosclerosis stroke.Atherosclerosis. 2015; 239: 328-334
- Metabolic syndrome in severe chronic kidney disease: prevalence, predictors, prognostic significance and effects of risk factor modification.Nephrol. (Carlton). 2007; 12: 391-398
- Independent components of chronic kidney disease as a cardiovascular risk state: results from the Kidney Early Evaluation Program (KEEP).Arch. Intern Med. 2007; 167: 1122-1129
- C-reactive protein and low albumin are predictors of morbidity and cardiovascular events in chronic kidney disease (CKD) 3-5 patients.Clin. Nephrol. 2007; 67: 352-357
- Comparison of associations of outcomes after stroke with estimated GFR using Chinese modifications of the MDRD study and CKD-EPI creatinine equations: results from the China National Stroke Registry.Am. J. Kidney Dis. 2014; 63: 59-67
Published online: December 11, 2017
Accepted: November 29, 2017
Received in revised form: October 26, 2017
Received: August 12, 2017
© 2017 Elsevier B.V. All rights reserved.
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- Stroke outcome is associated with baseline renal function: A risk factor that matters!AtherosclerosisVol. 269
- PreviewKidney disease and more specifically chronic kidney disease (CKD) prevalence is on the rise and it is estimated that the prevalence of CKD is almost 11–13% in the world . During the last twenty years, a number of studies have shown that patients with CKD have a higher risk for cardiovascular events including stroke and myocardial infarction [2–5]. Furthermore, CKD has been associated with an increased risk for all mortality and cardiovascular (CV) mortality . In light of this, it is not surprising that in this issue of Atherosclerosis Wang et al.