High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke

Watanabe, Yozo; Suda, Satoshi; Kanamaru, Takuya; Katsumata, T; Okubo, Seiji; Kaneko, Takeshi; Mii, Akiko; Sakai, Yukinao; Katayama, Yasuo; Kimura, Kazumi; Tsuruoka, Shuichi

doi:10.1111/nep.12745

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…Consistent with our results, albuminuria at levels of 10–29 mg/g is associated with greater risk of cardiovascular events, deaths, and heart failure in general population [11, 12, 29]. However, the level of albuminuria in previous studies evaluating relationship between ACR and stroke outcome is higher than 30 mg/g [1-5]. Therefore, there is a need to place more resources in the screening and intervention of high-normal albuminuria among the stroke population.…”

Section: Discussionsupporting

confidence: 90%

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Association of Urine Albumin-Creatinine Ratio and Cystatin C-Based Estimated GFR with Outcomes in Patients with Ischemic Stroke

Zhou

Pan

et al. 2022

Kidney Blood Press Res

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Background/Aims: Data about the independent and combined effects of cystatin C based estimated glomerular filtration rate (eGFRcys) and albuminuria on the risk of poor outcome in stroke patients is limited. The aim was to elucidate how these two renal markers affect the clinical outcomes after ischemic stroke separately and jointly. Methods: The study subjects consisted of 10,197 patients with ischemic stroke from the third China National Stroke Registry (CNSR-III). The study outcomes were all-cause mortality, post stroke disability, recurrence of stroke and cardiocerebral vascular disease (CVD) composite events. Cox proportional hazard models and multivariable logistic regression model were applied to evaluate the effects of eGFRcys and urine albumin–creatinine-ratio (ACR) on these outcomes. Results: Both reduced eGFRcys and increased ACR were independently associated with higher incidences of all-cause death and post stroke disability (p<0.01). Mildly decreased eGFRcys (60-89 mL/min/1.73 m2) is associated with increased risk of all-cause death and post stroke disability in the presence of high-normal ACR (10-29mg/g). Patients with both eGFRcys ＜45 mL/min/1.73 m2 and ACR ≥30mg/g at baseline had a 6.8-fold risk for all-cause mortality and 3.6-fold risk for post stroke disability, compared with patients with eGFRcys of 90-119 mL/min/1.73 m2 and ACR <10mg/g. In addition, increased ACR were associated with recurrent stroke and CVD composite event, while reduced eGFRcys showed no relationship with these outcomes. Conclusions: Both decreased eGFRcys and albuminuria are independent risk factors for all-cause death and post stroke disability. Combining the two markers is useful for improving risk stratification even in those without chronic kidney disease.

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Section: Discussionsupporting

confidence: 90%

“…stroke patients [1][2][3][4][5][6][7][8] as well as general population [9][10][11][12][13]. As an alternative filtration marker, cystatin C-based eGFR (eGFR cys ) has a stronger association with mortality and cardiovascular disease than does eGFR based on creatinine (eGFR cr ) and improves risk stratification [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Association of Urine Albumin-Creatinine Ratio and Cystatin C-Based Estimated GFR with Outcomes in Patients with Ischemic Stroke

Zhou

Pan

et al. 2022

Kidney Blood Press Res

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“…These findings were subsequently extended to individuals with stroke [6, 7]. The baseline ACR was also found to be independently associated with severe neurological deficits at stroke onset and a poor functional outcome at discharge after adjusting for confounding factors [14-16]. Our study is unique in that it repeated test of ACR at intervals of 3 months.…”

Section: Discussionmentioning

confidence: 67%

The Association between Baseline and 3-Month Albuminuria and 1-Year Prognosis of Ischemic Stroke

Wang

Pan

et al. 2021

Cerebrovasc Dis

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Introduction: The association between the changes in albuminuria levels and the clinical prognosis of stroke is unknown. The present study aimed to explore the relationships between changes in albuminuria and the risk of adverse stroke outcomes. Methods: The patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry (CNSR-III) who had the urinary albumin-to-creatinine ratio (ACR) detected at baseline and 3-month were recruited. They were classified into 4 groups according to baseline and 3-month ACR and followed up for 1 year. Results: A total of 5,311 patients were finally included in the study. There were 3,738 (70.4%), 483 (9.1%), 451 (8.5%), and 639 (12.0%) patients with no albuminuria, baseline albuminuria, 3-month albuminuria, and persistent albuminuria, respectively. After adjustment for confounding variables, persistent albuminuria was independently associated with all-cause death (hazard ratio [HR], 2.23; 95% CI, 1.17–4.25; p = 0.02), stroke recurrence (HR, 1.55; 95% CI, 1.02–2.36; p = 0.04), and poor functional outcome (OR, 2.22; 95% CI, 1.66–2.96; p < 0.001). Baseline albuminuria was independently associated with poor functional outcome (OR, 1.65; 95% CI, 1.19–2.28; p = 0.003), while 3-month albuminuria was independently associated with stroke recurrence (HR, 1.68; 95% CI, 1.06–2.65; p = 0.03). Conclusions: Changes in albuminuria can predict adverse 1-year outcomes in Chinese ischemic stroke patients. In particular, persistent albuminuria was independently associated with 1-year all-cause death, stroke recurrence, and poor functional outcome.

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“…Watanabe ve ark. [8] MA düzeyi 30 mg/günün üzerinde olan Aİİ hastalarında düzey yükseldikçe bunun kötü prognostik göstergelerden biri ve vasküler disfonksiyona yol açan bir risk faktörü olduğunu bildirmişlerdir.…”

Section: Yöntemunclassified

“…Daha önce yapılan çalışmalar akut myokard infarktüsü, geçici iskemik atak (GİA) ve Aİİ hastalarında MAÜ varlığının bağımsız bir risk faktörü olabileceğini düşündürmektedir. [8][9][10][11][12][13][14][15][16][17][18][19] Bu çalışmada, Aİİ olgularında MA değerlerinin araştırılması ve MAÜ varlığının diğer risk faktörleri ile ilişkisinin incelenmesi amaçlandı. Meng ve ark.…”

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Microalbuminuria in Patients withAcute Ischemic Stroke

Ak¹

2019

bogazicitip

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Objectives: This study aims to investigate the presence of microalbuminuria (MAU) as a risk factor in patients with acute ischemic stroke (AIS). Methods: Thirty patients (19 female and 11 male; mean age 69.4±11.9 years) hospitalized with the diagnosis of acute ischemic stroke were enrolled in this study. Microalbuminuria was assessed from the urine samples of patients obtained within 24 hours after the onset of ischemic stroke. Microalbuminuria was accepted as normal if the level was less than 30 mg/day and as high if the level was between 30-300 mg/day. Data obtained were compared with the data of the controls (16 female, 14 male; meanage 64.9±14.2). Results: A significant difference was not detected between the patients and the control groups for gender and mean ages. When data of the cases with AIS and data of the control group were compared, the mean microalbuminuria level of the AIS group was significantly higher than the control group. Microalbuminuria was present in 23 (76.6%) cases with AIS. Hypertension, diabetes mellitus, recent ischemic stroke, hypercholesterolemia, alcohol and smoking were found in 16 (53.3%), 9 (30.1%), 5 (16.6%), 18 (60.2%), 10 (33.3%), 12 (40.7%) cases with AIS, respectively. The incidence of microalbuminuria in cases with hypertension, diabetes, recent ischemic stroke, and cigarette smoking was significantly higher. Microalbuminuria was found in two (6.3%) cases of the control group. Conclusion: Our findings support the hypothesis that microalbuminuria may be a risk factor of ischemic stroke.

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High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke

Abstract: A high UACR at admission may predict a poor outcome at discharge in patients with acute ischaemic stroke.

Cited by 4 publications

References 38 publications

Association of Urine Albumin-Creatinine Ratio and Cystatin C-Based Estimated GFR with Outcomes in Patients with Ischemic Stroke

Association of Urine Albumin-Creatinine Ratio and Cystatin C-Based Estimated GFR with Outcomes in Patients with Ischemic Stroke

The Association between Baseline and 3-Month Albuminuria and 1-Year Prognosis of Ischemic Stroke

Microalbuminuria in Patients withAcute Ischemic Stroke

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