Kidney Dysfunction Increases Mortality and Incident Events after Young Stroke: The FUTURE Study

Abstract

Background: In about 30% of young stroke patients, no cause can be identified. In elderly patients, kidney dysfunction has been suggested as a contributing risk factor for mortality as well as stroke. There are hypotheses that novel non-traditional risk factors, like chronic inflammation and oxidative stress, are involved in chronic kidney disease, affecting the cerebral microvasculature that would in turn lead to stroke. Our objective is to investigate the influence of kidney dysfunction on long-term mortality and incident vascular events after stroke in young adults aged 18 through 50 and if this relationship would be independent of other cardiovascular risk factors. Methods: We prospectively included 460 young stroke patients with an ischemic stroke or transient ischemic attack admitted to our department between January 1, 1980 and November 1, 2010. Follow-up was done between 2014 and 2015. Estimated glomerular filtration rate (eGFR) was calculated from baseline creatinine levels and was divided in 3 subgroups: eGFR <60, 60-120 and >120 ml/min/1.73 m². Cox proportional hazard models were used to determine the effect of kidney dysfunction on mortality and incident vascular events, adjusting for cardiovascular risk factors. Results: An eGFR <60 (HR 4.6; 95% CI 2.6-8.2) was associated with an increased risk of death and an increased risk of incident stroke (HR 4.1; 95% CI 1.9-9.0) independent of cardiovascular risk factors, but it was not associated with other vascular events. The point estimate for the 15-year cumulative mortality was 70% (95% CI 46-94) for patients with a low eGFR, 24% (95% CI 18-30) for patients with a normal eGFR and 30% (95% CI 12-48) for patients with a high eGFR. The point estimate for the 15-year cumulative risk of incident stroke was 45% (95% CI 16-74) for patients with a low eGFR, 13% (95% CI 9-17) for patients with a normal eGFR and 8% (95% CI 0-18) for patients with a high eGFR. Conclusions: Kidney dysfunction is related to long-term mortality and stroke recurrence, but not to incident cardiovascular disease, on average 11 years after young stroke. This warrants a more intensive follow-up of young stroke patients with signs of kidney dysfunction in the early phase. In addition, the clear association between kidney dysfunction and incident stroke seen in our young stroke population might be a first step in the recognition of kidney dysfunction as a new risk factor for the development of stroke at young age. Also, it can lead to new insights in the etiological differences between cardiovascular and cerebrovascular disease.

Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study

“…Consequently, these two conditions might partly mediate the association between insomnia and death. Some studies found that patients with stroke who also had CVD or kidney dysfunction had a higher risk of death 15 36. In this study, subjects with severe physical illness were excluded, which might explain the weak statistical power of the result.…”

“…Medical history, past psychiatric diagnosis, vascular risk factors (eg, history of hypertension, diabetes and smoking), clinical characteristics such as type of stroke and National Institute of Health Stroke Scale (NIHSS) score for the first time after admission, and other medical complications (eg, atrial fibrillation, urinary disease and tumours) were also collected at intake time. Exclusion criteria were patients who had a history of stroke; patients with obvious aphasia that impeded the patient from finishing psychological assessment; patients who withdrew from follow-up at any of the following time points; and patients with severe heart disease or nephropathy or tumour, or a history of psychiatric diagnosis, as the above conditions were shown to be associated with insomnia and mortality 15 16…”

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

“…Evidence not only suggests that RD is an independent risk factor for cardiovascular events, including stroke and myocardial infarction [13,14,15], but also indicates that RD is associated with worse functional and clinical outcome in ischemic stroke patients [4,16]. …”

Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke

“…In addition, distinctive risk profiles, mechanisms of stroke, and racial disparities have been suggested in several population studies of ischemic stroke in the dialysis population 2, 3, 4, 5, 6, 7, 8, 9. Dialysis status has also been shown to be an independent predictor of in‐hospital mortality following acute stroke 2, 5, 10, 11, 12. However, contemporary studies focusing on the incidence, characteristics, and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis are sparse.…”