Renal dysfunction and 30-day mortality risk in patients with acute stroke (original) (raw)
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Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke
Atherosclerosis, 2017
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 ...
Journal of clinical neurology (Seoul, Korea), 2015
Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study. This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2). The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score ≥3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of ≥4 at discharge compared to baseline) during hospitalization and in-hospital mortality. The overall eGFR was 84.5±20.8 mL/min/1.73 m(2...
Estimated glomerular filtration rate and risk of survival in acute stroke
Journal of the Neurological Sciences, 2013
Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate. Design: A prospective observational cross-sectional study. Setting: Medical wards of a tertiary care hospital. Subjects: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured. Outcome measures: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60ml/min and ≥ 60ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and ≥ 6.5) was determined by Breslow-Day and Tarone's test. Matanel Hazensel and Cochran's tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable. Results: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p<0.001, <0.001, <0.001). RR of survival and death for the GFR groups-less than 60ml/min and above or equal to 60ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60ml/min compared to GFR above or equal to 60ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p=0.612 and 0.612. Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute stroke
Medicine, 2017
Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients' outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (<60 mL/min/1.73 m), and 556 patients had a normal eGFR (≥90 mL/min/1.73 m). A total of 694 patients suffered from cerebral artery stenosis, i...
Chronic Kidney Disease and Clinical Outcome in Patients With Acute Stroke
Stroke, 2009
Background and Purpose-Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. Our aim was to examine the association between estimated glomerular filtration rate (GFR) and stroke outcome and to assess whether CKD and its severity affect stroke outcome in a large cohort of unselected patients with acute stroke. Methods-We examined the association between baseline estimated GFR and CKD and 1-year outcomes in 821 consecutive patients with acute stroke (ischemic or hemorrhagic). GFR was estimated by 2 methods: the Modification of Diet in Renal Disease and the Mayo Clinic quadratic equation. An estimated GFR rate Յ60 mL/min/1.73 m 2 defined CKD. Results-Odds ratios (95% CI) for death across levels of estimated GFR based on both equations were estimated. CKD was present in 36% of patients based on the Modification of Diet in Renal Disease equation and 18% (nϭ147) based on the Mayo Clinic equation. The adjusted ORs for mortality after 1-year based on the Modification of Diet in Renal Disease equation were 0.7 (95% CI, 0.4 to 1.2) associated with GFR 45 to 60 and 3.2 (1.7 to 6.4) associated with GFR 15 to 44 as compared with GFR Ͼ60 mL/min/1.73 m 2 , whereas those based on the Mayo Clinic equation were 2.3 (1.1 to 4.7) and 3.3 (1.6 to 7.1), respectively. The adjusted ORs for Barthel Index Յ75 or death after 1 year were 0.8 (0.5 to 1.5) and 2.1 (0.9 to 4.8) by the Modification of Diet in Renal Disease equation and 1.9 (0.8 to 4.4) and 3.9 (1.5 to 11.0) by the Mayo Clinic equation, respectively. Conclusions-CKD is a strong independent predictor of mortality and poor outcome in patients with acute stroke. The estimation of the prevalence of CKD and of the GFR cutoffs associated with poor outcome depend on the equation used to estimate GFR. (Stroke. 2009;40:1296-1303.)
Introduction: Stroke is considered the second leading cause of death globally. Chronic kidney disease (CKD) has been identified as a risk factor for stroke. However, little is known about the impact of renal dysfunction on early mortality following acute ischemic stroke. The aim of the current study was to evaluate the prevalence of renal dysfunction among acute ischemic stroke patients and its role on the early overall mortality. Patients and methods: This prospective cohort study included a total of 889 patients with first ever ischemic stroke who were hospitalized within 24 hours of symptoms onset. All patients were clinically evaluated to determine stroke risk factors. Stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS) in the 1st day of admission. Baseline investigations were obtained within 24 hours of admission, including serum creatinine and estimated Glomerular Filtration Rate (eGFR) that was calculated from the equation of the Modification Diet for Renal Disease in ml/min/1.73m2. Patients were followed up for 30 days after admission or at least until death. Results: Of the 800 stroke patients who completed follow up during the study period, 242 (30.2%) had renal dysfunction, and 128 (16%) died within 30-days of stroke onset, whereas mortality was higher (19.8%) in patients with eGFR <60 ml/min/1.73m2 than in patients (14%) with eGFR ?60 ml/min/1.73m2. In multivariate analysis, 30–days mortality risk of stroke was higher in patients with eGFR< 60ml/min/1.73 m2 (HR= 1.7, 95% CI=1.4–2, P=0.002), stroke severity (HR= 1.5, 95% CI=1.3- 1.7, P=0.001), and presence of atrial fibrillation (HR= 1.4, 95% CI=1.1-1.7, P=0.007). Meanwhile, the odds of mortality risk increased by 1.7 for each 1 mg/dl increase in baseline serum creatinine. Conclusion: The prevalence of renal dysfunction in our cohort of acute ischemic stroke patients was high. Presence of baseline renal dysfunction was recorded as an independent predictor of early mortality in the setting of acute ischemic stroke beside other well-known prognostic factors.
Atherosclerosis, 2015
Atherosclerosis 239 (2015) 328e334 adjusted hazard ratio of 21.19 (95% CI, 9.69e46.35) in patients with NIHSS >15 and eGFR <15 mL/min/ 1.73 m 2 , compared with those with NIHSS 0e5 and eGFR 60e119 mL/min/1.73 m 2 . Conclusions: Low eGFR was significantly and independently associated with 6-month functional outcomes and mortality in patients with the LAA subtype of acute ischemic stroke. The deleterious relationship between low eGFR levels and mortality following stroke was exacerbated by its synergistic association with stroke severity.
Journal of Atherosclerosis and Thrombosis, 2018
Aim: Although renal dysfunction has been identified as a novel risk factor affecting stroke prognosis, few have analyzed the association within large-scale population-based setting, using wide-range estimated glomerular filtration rate (eGFR) category. We aimed to determine the association of admission eGFR with acute stroke outcomes using data from a registry established in Shiga Prefecture, Japan. Methods: Following exclusion of patients younger than 18 years, with missing serum creatinine data, and with onset more than 7 days prior to admission, 2,813 acute stroke patients registered in the Shiga Stroke Registry year 2011 were included in the final analysis. The Japanese Society of Nephrology equation was used to estimate GFR. Multivariable logistic regression was performed to analyze the association of eGFR with all-cause in-hospital death (modified Rankin Scale [mRS] 6), and atdischarge death/disability (mRS 2–6). Separate analyses were conducted within stroke subtypes. Results...