Chronic kidney disease and risk of death during hospitalization for stroke

Ovbiagele, Bruce

doi:10.1016/j.jns.2010.11.002

Cited by 50 publications

(40 citation statements)

References 32 publications

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“…The relationship between chronic kidney disease and stroke mortality was rarely reported in literature. Ovbiagele (2011) reported that the presence of chronic kidney disease is independently associated with a higher odds ratio of death during stroke hospitalization regardless of index stroke type; however, the researchers did not further correlate the longterm mortality of stroke and chronic renal illness. In the current study, the risks of one-year mortality in both types of stroke complicated with chronic renal insufficiency both exhibited a nearly two-fold increase.…”

Section: Discussionmentioning

confidence: 93%

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Chen

Lee

et al. 2014

Tohoku J. Exp. Med.

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Long-term follow-up and comparison of serial changes in the one-year mortality after stroke are important in assessing the quality of stroke management. This study determined the one-year survival rate and prognostic factors of hospitalized hemorrhagic and ischemic stroke patients from 1991 to 2008 in a teaching hospital in Taiwan. We also evaluated the improvements in the one-year mortality after stroke during an 18-year study period. Patients admitted for cerebral hemorrhage (n = 3,678) and cerebral infarction (n = 16,010), identified from an in-patient electronic database, were linked to the National Death Registry of Taiwan. Actuarial analysis was used to determine the one-year survival rates, and Cox proportional hazard regression model was used to investigate the predictors for the one-year mortality of stroke patients. For patients with cerebral hemorrhage and infarction and who were admitted from 1991 to 2008, the one-year survival rates were 71% and 84%, respectively. In addition, stroke patients who also suffered from myocardial infarction, chronic renal illness, and pneumonia and had high Charlson comorbidity index scores showed increased risks of mortality due to cerebral hemorrhage and infarction. Compared with the patients admitted from 1991 to 1996, those admitted from 1997 to 2002 and from 2003 to 2008 showed 15%-20% and 20%-25% reduction in one-year mortality risk in cerebral hemorrhage and infarction, respectively. This result demonstrates the continuous quality improvement of stroke management in the hospital from 1991 to 2008. Further reduction in one-year mortality can be achieved by early recognition and prompt treatment of certain comorbidities.

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Section: Discussionmentioning

confidence: 93%

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Chen

Lee

et al. 2014

Tohoku J. Exp. Med.

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“…For example, rates of hospital admission and inpatient mortality for an acute myocardial infarction or heart failure were reported to be increased in patients with kidney disease and amplified in advanced CKD stages (11)(12)(13)(14)(15). Similarly, patients admitted with a diagnosis of stroke or pneumonia also had increased risk of in-hospital mortality by CKD stages (16,17). Compared with Medicare beneficiaries with other chronic illnesses (cancer, chronic obstructive pulmonary disease, depression, diabetes, and heart The CKD cohort did not include patients treated by hemodialysis, peritoneal dialysis, or kidney transplant.…”

Section: Discussionmentioning

confidence: 99%

Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

Daratha

Short

Corbett

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Rates of hospitalization are known to be high in patients with kidney disease. However, ongoing risks of subsequent hospitalization and mortality are uncertain. The primary objective was to evaluate patients with kidney disease for long-term risks of subsequent hospitalization, including admissions resulting in death. (n=6131), kidney transplant (n=1100), and reference (n=641,242) cohorts. Cox proportional hazard models controlling for age, sex, payer, comorbidity, previous hospitalization, primary diagnosis category, and length of stay were conducted for time to event analyses.Results Compared with the reference cohort, risks for subsequent hospitalization were increased in the CKD (hazard ratio=1.20, 99% confidence interval=1.18-1.23, P,0.001), dialysis (hazard ratio=1.76, 99% confidence interval=1.69-1.83, P,0.001), and kidney transplant (hazard ratio=1.85, 99% confidence interval=1.68-2.03, P,0.001) cohorts, with a mean follow-up time of 29 months. Similarly, risks for fatal hospitalization were increased for patients in the CKD (hazard ratio=1.41, 99% confidence interval=1.34-1.49, P,0.001), dialysis (hazard ratio=3.04, 99% confidence interval=2.78-3.31, P,0.001), and kidney transplant (hazard ratio=2.25, 99% confidence interval=1.67-3.03, P,0.001) cohorts. Risks for hospitalization and fatal hospitalization increased in a graded manner by CKD stage.Conclusions Risks of subsequent hospitalization, including admission resulting in death, among patients with kidney disease were substantially increased in a large statewide population. Patients with kidney disease should be a focus of efforts to reduce hospitalizations and mortality.

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“…46 This study showed that although estimated GFR was associated with increased risk, the risk was lower than that observed for cystatin C. 46 Possible reasons for the stronger association between serum cystatin C and mortality compared to creatinine and estimated GFR are not completely clear, but are likely due, at least in part, to non-GFR determinants of serum cystatin C. 47 In previous studies, it was documented that renal dysfunction is independent predictor of short-and long-term mortality in patients with stroke. [9][10][11][12][13][14] In most studies, creatinine or estimated GFR based on creatinine were used to define renal dysfunction. The predictive value of cystatin C has not been fully established in patients suffering from ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Furthermore, renal dysfunction was also an independent predictor of mortality in patients with stroke. 9,[11][12][13] Patients with renal dysfunction are also at greater risk of future ischemic stroke. 14 Estimation of the glomerular filtration rate (GFR) is essential for the evaluation of patients with kidney disease.…”

Section: Introductionmentioning

confidence: 99%

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

2013

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Renal dysfunction is associated with mortality in patients after ischemic stroke. Cystatin C is a potentially superior marker of renal function compared to creatinine and estimated glomerular filtration rate (GFR). In our observational cohort study, 390 Caucasian patients suffered from acute ischemic stroke (mean age 70.9 years; 183 women and 207 men) were included and prospectively followed up to maximal 56 months. Serum creatinine and cystatin C were measured at admission to the hospital; GFR was estimated according to CKD-EPI creatinine and CKD-EPI creatinine/cystatin equations. According to values of serum creatinine, estimated GFR and serum cystatin C patients were divided into quintiles. In the follow-up period, 191 (49%) patients died. For serum cystatin C and estimated GFR based on creatinine and cystatin C, the mortality and the hazard ratios for long-term mortality increased from the first to the fifth quintile nearly linearly. The associations of serum creatinine and estimated GFR categories based on creatinine with long-term mortality were J-shaped. As compared with lowest quintile of serum cystatin C, the fifth quintile was associated with long-term mortality significantly also after multivariate adjustment (age, gender, initial stroke severity, known risk factors for stroke mortality). In contrast, in adjusted analysis serum creatinine and estimated GFR (CKD-EPI creatinine and CKD-EPI creatinine/cystatin) were not associated with long-term mortality. In summary, serum cystatin C was independently and better associated with the risk of long-term mortality in patients suffering from ischemic stroke than were creatinine and estimated GFR using both CKD-EPI equations.

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Chronic kidney disease and risk of death during hospitalization for stroke

Cited by 50 publications

References 32 publications

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

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