Estimated glomerular filtration rate and risk of poor outcomes after stroke

Abstract

Background and purpose The relationship of the estimated glomerular filtration rate (eGFR) with complications after stroke has not been fully characterized for the entire clinical spectrum of eGFR and for the fluctuation in eGFR during hospital stay. Methods Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 were analysed. eGFR was categorized into six clinically relevant categories as per the Kidney Disease Improving Global Outcomes guidelines. The change in eGFR during acute admission was categorized into the following: within 5% change (reference), 5%–20% decline, >20% decline, 5%–20% increase and >20% increase. All‐cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest. Results In all, 10 329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30 126 person‐years). Multivariable adjusted hazard ratios (95% confidence interval) for all‐cause mortality were 0.91 (0.80–1.04), 0.96 (0.83–1.11), 1.23 (1.06–1.43), 1.54 (1.31–1.82) and 2.38 (1.91–2.97) for eGFR levels 60–89, 45–59, 30–44, 15–29 and <15 respectively, compared to eGFR ≥ 90 ml/min/1.73 m2. The hazard ratios (95% confidence interval) for eGFR change were 1.56 (1.36–1.79), 1.17 (1.05–1.30), 1.47 (1.32–1.62) and 1.71 (1.55–1.88) for >20% decline, 5%–20% decline, 5%–20% increase and >20% increase, respectively, compared to change within 5%. Results were similar for other outcomes except recurrent stroke. Conclusions Stroke patients with eGFR < 45 ml/min/1.73 m2 at hospital admission and >5% decline or increase in eGFR during hospital stay were at substantially higher risk of poor outcomes, particularly all‐cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.

Thrombolysis in acute ischaemic stroke patients with chronic kidney disease

“…The results of our study are consistent with previous literature highlighting the association between CKD and adverse AIS in‐hospital outcomes 7 . Furthermore, our results highlight that CKD patients without ESRD exhibited relatively small increases (4–13%) in the odds of adverse outcomes, while ESRD was associated with higher increases (34–106%), consistent with the previously reported dose‐response relationship between decreasing glomerular filtration rate and adverse AIS outcomes 7 . In terms of thrombolysis for AIS, previous investigations found that CKD was associated with adverse outcomes amongst AIS patients receiving thrombolysis, 11,12,13,24,37,38 thus highlighting CKD as a potential contraindication to thrombolysis for stroke.…”

“…The results of our study are consistent with previous literature highlighting the association between CKD and adverse AIS in‐hospital outcomes 7 . Furthermore, our results highlight that CKD patients without ESRD exhibited relatively small increases (4–13%) in the odds of adverse outcomes, while ESRD was associated with higher increases (34–106%), consistent with the previously reported dose‐response relationship between decreasing glomerular filtration rate and adverse AIS outcomes 7 .…”

“…The results of our study are consistent with previous literature highlighting the association between CKD and adverse AIS in-hospital outcomes. 7 Furthermore, our results highlight that CKD patients without ESRD exhibited relatively small increases (4-13%)…”

“…in the odds of adverse outcomes, while ESRD was associated with higher increases (34-106%), consistent with the previously reported dose-response relationship between decreasing glomerular filtration rate and adverse AIS outcomes. 7 In terms of thrombolysis for AIS, previous investigations found that CKD was associated with adverse outcomes amongst AIS patients receiving thrombolysis, 11,12,13,24,37,38 thus highlighting CKD as a potential contraindication to thrombolysis for stroke. Nevertheless, other investigations have not found an association between CKD and adverse AIS outcomes, including intracranial haemorrhage, in patients undergoing thrombolysis.…”

“…5 CKD is known to increase the risk of bleeding, raising the question of whether caution should be exercised when undertaking thrombolysis in patients with CKD. 6 While CKD has been previous established as a poor prognostic factor in AIS, 7 previous studies evaluating the association between CKD and thrombolysis outcomes in patients with AIS have remained equivocal. Observational study findings are conflicting, with some studies concluding that renal dysfunction should not be a contraindication to thrombolysis, 6,8,9,10 while others reporting the contrary.…”