Does Renal Dysfunction Predict Mortality After Acute Stroke?

Abstract

Background and Purpose-The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke. Methods-This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality. Results-The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine Ͻ124 mol/L.The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance Ն51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine Ն119 mol/L [relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92], urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or Ն9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine Ն0.08573 mmol/mol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders. Conclusions-After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.

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

“…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.…”

“…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.…”

Chronic Kidney Disease, Cardiovascular Events, and the Effects of Perindopril-Based Blood Pressure Lowering

“…19 Similar relationships between kidney function and the risk for coronary heart disease and death were also found. The importance of the increased risk for stroke is highlighted by data suggesting that outcomes after stroke are particularly poor in people with early 20 or advanced CKD. 21 The use of a perindopril-based BP-lowering regimen produced a separately statistically significant 30% (95% CI 14 to 42%; P ϭ 0.002) reduction in the risk for major cardiovascular events among the 1757 participants in the PROGRESS who had CKD at baseline.…”

Ischemic stroke in patients with intermittent claudication: a clinical study of 142 cases

“…In addition, in the study of Bowling et al, 31 intermittent claudication, angina pectoris, advancing age, male gender, and computed tomographic evidence of any cerebral infarct especially a watershed infarct or white matter hypodensity ¡ factors that were all present and associated with ischemic stroke in patients with intermittent claudication in our study ¡ were independent risk factors for major vascular events (stroke, myocardial infarction, or vascular death) in patients with a recent TIA or minor stroke. In another study, 23 renal dysfunction was a signi cant predictor of increased mortality in acute stroke patients in both the short-and long-term. In the present study, the early prognosis of patients with ischemic stroke with and without claudication was similar, with no differences in the percentages of in-hospital mortality (16% vs 14%) and absence of functional limitation at hospital discharge (20.5% vs 18.5%).…”