Association between Renal Function and Clinical Outcome in Patients with Acute Stroke

Abstract

Background and Purpose: Data on the association between renal dysfunction and outcome in patients with stroke are controversial and scarce. We investigated the predictors of renal dysfunction upon admission and the association between renal dysfunction and clinical outcome in patients with acute stroke in a hospitalized Chinese population. Methods: 1,758 acute stroke patients were consecutively enrolled into the study. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease equation. Reduced estimate of the glomerular filtration rate was defined as eGFR <60 ml/min/1.73 m². Multivariate logistical regression was used to evaluate the predictors of renal dysfunction upon admission and to examine the association between renal dysfunction and outcomes. The main outcome measures were death and death/disability (disability defined as modified Rankin Scale score >2) at 12 months after stroke. Results: Of the included 1,758 cases (ischemic stroke: n = 1,192; hemorrhagic stroke: n = 566), 463 cases had reduced eGFR, which accounted for 26.3% of the total number. The distribution of eGFR upon admission was normal and the mean was 75.87 ± 38.31 ml/min/1.73 m² (ischemic stroke: 75.07 ± 29.89 ml/min/1.73 m²; hemorrhagic stroke: 77.57 ± 51.73 ml/min/1.73 m²). There was no significant difference between the two groups (p = 0.285). The independent predictors of eGFR upon admission were age (OR = 1.039, 95% CI = 1.028–1.050), male gender (OR = 0.658, 95% CI = 0.504–0.859), hematocrit on admission (OR = 1.008, 95% CI = 1.003–1.013), history of hypertension (OR = 1.307, 95% CI = 1.034–1.653), history of diabetes (OR = 1.411, 95% CI = 1.012–1.967) and NIHSS scores upon admission (OR = 1.497, 95% CI = 1.286–1.743). After adjustment for confounders, the patients with renal dysfunction had a significantly higher risk of death/disability (OR = 1.864, 95% CI = 1.170–2.970) compared with patients whose eGFR was more than 90 ml/min/1.73 m² at the end of the 12th month. Further analysis on type of stroke showed that reduced eGFR was an independent predictor of death/disability at the end of the 12th month in patients with hemorrhagic stroke (OR = 2.353, 95% CI = 1.063–5.209), but not for ischemic stroke (OR = 1.625, 95% CI = 0.881–2.999). Conclusions: Our study indicated that more than 1/4 of all patients with acute stroke presented with renal dysfunction. Reduced eGFR on admission is a strong predictor of poor outcome for hemorrhagic stroke but not for ischemic stroke.

Association of Glomerular Filtration Rate With Outcomes of Acute Stroke in Type 2 Diabetic Patients: Results From the China National Stroke Registry

“…Some studies suggested that reduced eGFR is associated with a poor outcome in ischemic stroke patients (18,19), whereas other studies do not (20,21). Mittleman and colleagues (19) recently demonstrated that a reduced or highly elevated eGFR (,60 or .125 mL/min/1.73 m 2 ) was associated with a higher mortality rate compared with patients with moderate levels of eGFR in 1,175 acute ischemic stroke patients.…”

Hyperglycaemia in acute lacunar stroke: A Chinese hospital-based study

“…A detailed study design and methods have been previously published. 23 Continuous data are presented as the mean ± standard deviation (SD) or median and interquartile range (IQR) (25th to 75th percentile) in the case of non-normal distributions. Discrete data are given as counts and percentages.…”

Renal impairment in stroke patients: A comparison between the haemorrhagic and ischemic variants

“…In Hao et al’s (2010) study, the mean e-GFR at admission in the haemorrhagic and ischemic stroke groups were comparable 77.57 ± 51.73 vs 77.07 ± 29.89 (p=0.285) 19 . Patients presented to our centre at various times following the index stoke; hence, the days mentioned are not the days after the stroke event, but the days after admission to the hospital.…”