Renal dysfunction predicts mortality in type 2 diabetic patients suffering from an acute ischemic stroke (original) (raw)
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Renal Function Predicts Outcomes in Ischemic Stroke and Hemorrhagic Stroke
International Journal of Science and Research, 2024
Renal dysfunction has been suggested as risk factor and prognostic factors in cerebrovascular diseases. Regarding the association of renal dysfunction with stroke subtypes, conflicting results have been observed. The aim of this study was to evaluate renal function and the impact of renal function on in-hospital outcomes in hospitalized patients with ischemic and hemorrhagic stroke. We conducted a retrospective cohort study in a sample of 311 hospitalized patients with acute stroke at Department of Neurology, Khmer Soviet Friendship Hospital from January 1, 2020 to June 30, 2021. Mann-Whitney test was used to compare the values of variables between the 2 groups. Multivariate logistic regression was used to identify the independent risk factors for mortality in stroke. In analysis of the impact of severity, variables were standardized for age by arbitrary inclusion of this variable in the model. In addition, for models with a larger number of independent variables, stepwise method was used to eliminate variables (as a criterion for accepting the value of the Wald statistics). Of 311 stroke patients, 52.73% were male and the mean age of 62 years old. There were 84.88% ischemic stroke. The mean serum creatinine on admission in patients with both types of stroke was significantly higher in hemorrhagic stroke. Multivariate analysis showed that independent predictors of severity in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital severity among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke.
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.
Ischaemic stroke – impact of renal dysfunction on in-hospital mortality
European Journal of Neurology, 2007
Renal dysfunction predicts mortality in patients with myocardial infarction but less is known about the impact of renal dysfunction on in-hospital mortality after ischaemic stroke. All 361 patients (185 men, 176 women; mean age 72.1 years) with ischaemic stroke and glomerular filtration rate (GFR) <90 ml/min/1.73 m 2 were followed-up. GFR was calculated according to abbreviated modification of diet in renal disease (MDRD) formula. Stroke severity was determined by National Institutes of Health Stroke Scale (NIHSS). The mean GFR was 61.5 ± 16.6 ml/min/1.73 m 2 . There were 49 (13.6%) in-hospital deaths. Patients who died had higher NIHSS (P ¼ 0.0001), were older (P ¼ 0.024), had lower GFR (P ¼ 0.028), higher hs-C-reactive protein (P ¼ 0.001) and lower albumin (P ¼ 0.048). No differences in presence of diabetes and hypertension, cholesterol (total, HDL and LDL), triglycerides and BMI between patients who died or survived were found. With univariate analysis association between in-hospital mortality and NIHSS (P ¼ 0.0001), GFR (P ¼ 0.041), total cholesterol (P ¼ 0.021) and LDL cholesterol (P ¼ 0.034) was found. With Cox multivariable regression analysis of risk factors, NIHSS (P ¼ 0.0001), GFR (P ¼ 0.018), total cholesterol (P ¼ 0.008) and LDL cholesterol (P ¼ 0.011) were only predictors of in-hospital mortality. In patients with ischaemic stroke, decreased GFR was associated with higher in-hospital mortality.
Renal Dysfunction in Post-Stroke Patients
PLOS ONE, 2016
Background The presence of chronic kidney disease (CKD) is an indicator of a worse long-term prognosis in patients with ischemic stroke (IS). Unfortunately, not much is known about renal function in the population of post-IS subjects. The aim of our study was to assess the prevalence of renal damage and impaired renal function (IRF) in the population of post-IS subjects. Methods This prospective analysis concerned 352 consecutive post-IS survivors hospitalized in Pomeranian stroke centers (Poland) in 2009. In this group estimated glomerular filtration rate (eGFR) according to MDRD (modification of diet in renal diseases) and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formulas and urine albumin/creatinine ratio (ACR) were determined. Results Among survivors decreased eGFR (<60 mL/min./1.73m 2 according to MDRD or CKD-EPI) or ACR30mg/g were detected in 40.38% (23.07% Men, 55.32% Women; P<0.01). The highest prevalence of IRF was noted in post-IS subjects with atheromatic and lacunar IS. In multivariate analysis the ACR30mg/g was predicted by older age, diabetes mellitus (DM) and physical disability (modified Rankin scale 3-5 pts.). The association with reduced eGFR was proved for sex (female), DM and physical disability. Conclusions CKD is a frequently occurring problem in the group of post-IS subjects, especially after lacunar and atheromatic IS. Post-IS patients, mainly the elderly women, with physical disability and diabetes mellitus, should be regularly screened for CKD. This could reduce the risk of further cardiovascular events and delay the progression of IRF.
Renal Function Abnormalities Among Hospitalized Stroke Patients
2022
BACKGROUND: Stroke is the leading cause of neurological disability and the second commonest cause of death globally. Despite the fact that renal dysfunction is a common comorbidity of stroke, there is no data on the prevalence of renal dysfunction among patients with acute stroke in Ethiopia. The aim of this study was to determine the magnitude of renal dysfunction, factors associated with renal dysfunction and risk of in-hospital mortality. METHODS: A hospital-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College among consecutive 192 patients, who were admitted with acute stroke from September 2020 to September 2021. Data were collected using a structured questionnaire after pilot survey was done. A Multivariate binary logistic regression analysis was fitted to identify determinants of renal function abnormalities. Renal dysfunction was defined as serum creatinine >1.2mg/dl. RESULT: The mean age (SD) of study participants was 62.2 (15.9) years. Hundred-one (52.6%) participants were males. Thirty-four (17.7%) of the participants had renal dysfunction. Among patients with renal dysfunction, more than half of them were ≥70 years old and two-thirds were males. Male gender and hypertension increased the risk of renal dysfunction among hospitalized stroke patients. The mortality rate was higher in stroke patients with renal dysfunction (35.3%) as compared with patients having normal renal function (15.2%), but it was not a statistically significant. CONCLUSION: Renal dysfunction was a frequent comorbidity among acute stroke patients who were hospitalized. Male gender and hypertension were statistically significant predictors of renal dysfunction. Mortality rate was higher in stroke patients with renal dysfunction, but not a statistically significant predictor of post stroke in-hospital mortality.
Chronic Kidney Disease in Patients with Ischemic Stroke
Journal of Stroke and Cerebrovascular Diseases, 2012
To examine the significance of renal dysfunction in patients who have sustained ischemic stroke, we examined the relationship between the renal function evaluated in terms of estimated glomerular filtration rate (eGFR) and the subtype of brain infarction (BI) in patients with ischemic stroke. A total of 639 patients with BI were enrolled in this study, with 314 subjects without stroke or transient ischemic attack registered as age-matched controls. eGFR was calculated according to the equation 194 3 Cr 21.094 3 Age 20.287 (20.739 if female), where Cr is serum creatinine concentration, and was classified into four stages: stage I, eGFR $90 mL/min/1.73 m 2 ; stage II, eGFR 6089 mL/min/1.73 m 2 ; stage III, eGFR 3059 mL/min/1.73 m 2 ; and stage IV, eGFR ,29 mL/min/1.73 m 2 . Stage III-IV was significantly more prevalent in the BI group (38%) than in the control group (22%; P , .001). The odds ratio for stage III-IV was significantly higher in the BI group (1.93; 95% confidence interval [CI], 1.35-2.76). Among the BI subgroups, the odds ratios of stage III-IV for the atherothrombotic type (1.81; 95% CI, 1.23-2.68) and the cardiogenic type (2.25; 95% CI, 1.32-3.83) were significantly higher than that of the control group, but that of stage III-IV for lacunar type was not (1.67; 95% CI, 0.98-2.84). Our results indicate that ischemic stroke is frequently associated with renal dysfunction. Chronic kidney disease might be independent risk factor for infarction, especially for cardiogenic and atherosclerotic types.
Predictors of in-hospital mortality after acute stroke: impact of renal dysfunction
Int. Journal of Clinical Pharmacology and Therapeutics, 2008
The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of inhospital mortality. Statistical analysis was carried out using SPSS 15.A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital. Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P= 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.