Low glomerular filtration rate and risk of stroke: meta-analysis

Abstract

Objective To qualitatively and quantitatively investigate the link between a low estimated glomerular filtration rate (eGFR) at baseline and risk of future stroke. Design Systematic review and meta-analysis of prospective studies. Data sources PubMed (1966-October 2009 and Embase (1947-October 2009. Selection criteria Inclusion criteria were studies that prospectively collected data within cohort studies or clinical trials, estimated glomerular filtration rate at baseline using the modification of diet in renal disease or Cockcroft-Gault equations, assessed incident stroke, had a follow-up of at least one year, and reported quantitative estimates of multivariate adjusted relative risk and 95% confidence interval for stroke associated with an eGFR of 60-90 ml/min/1.73 m 2 or <60 ml/min/1.73 m 2 . Data abstraction Two investigators independently abstracted data from eligible studies. Estimates were combined using a random effects model. Heterogeneity was assessed by P value of χ 2 statistics and I 2 . Publication bias was assessed by visual examination of funnel plots. Results 21 articles derived from 33 prospective studies: 14 articles assessed eGFR <60 ml/min/1.73 m 2 and seven assessed eGRF at both <60 ml/min/1.73 m 2 and 60-90 ml/min/1.73 m 2 for a total of 284 672 participants (follow-up 3.2-15 years) with 7863 stroke events. Incident stroke risk increased among participants with an eGFR <60 ml/min/1.73 m 2 (relative risk 1.43, 95% confidence interval 1.31 to 1.57; P<0.001) but not among those with an eGFR of 60-90 ml/min/1.73 m 2 (1.07, 0.98 to 1.17; P=0.15). Significant heterogeneity existed between estimates among patients with an eGFR <60 ml/min/1.73 m 2 (P<0.001). In subgroup analyses among participants with an eGFR <60 ml/min/1.73 m 2

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

“…Our findings do not suggest that the association between declining renal function and CVD is stronger or starts at higher eGFR levels in HIV-positive persons than in the general population, as was hypothesized on the basis of the higher occurrence of common renal and CVD risk factors and increased immune activation [1,4,33,34]. There is, however, ongoing ambiguity in the general population with regard to the strength of the association between impaired renal function and CVD.…”

“…The association between impaired renal function and cardiovascular disease (CVD) is well established in the general population, particularly for severe levels of renal impairment [1][2][3][4][5][6]. As such, >50% of all deaths among individuals with end-stage renal disease are related to a CVD event [7].…”

Life after Acute Kidney Injury

“…In der bereits erwähnten verlänger-ten Nachbeobachtung der RENAL-Studie zeigte sich bei einer Nachuntersuchungsdauer von im Median 43,9 Monaten (Interquartilsabstand 30,0-48,6 Monate) bei Patienten mit niedriger Dialyseintensität eine Mortalität von 63 % gegenüber 62 % bei Patienten mit erhöh-ter Intensität [19]. Es wurde auch gezeigt, dass bereits ein erstgradiges ANV (nach "propensity score matching") mit einem reduzierten 10-Jahres-Überleben einhergeht (p = 0,036; [44] [42]. [42].…”

“…Es wurde auch gezeigt, dass bereits ein erstgradiges ANV (nach "propensity score matching") mit einem reduzierten 10-Jahres-Überleben einhergeht (p = 0,036; [44] [42]. [42].…”

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

“…Chronic kidney disease has been associated with an increased risk of stroke in the general population,7 but whether CKD is a prognostic factor of stroke in patients with HF has not been investigated. Also, CKD has been associated with an increased risk of haemorrhagic stroke and major bleeding in patients with cardiovascular disease,8, 9 although this has not been specifically described in the HF population.…”