Indices of Kidney Dysfunction and Discharge Outcomes in Hospitalized Stroke Patients without Known Renal Disease

Ovbiagele, Bruce; Sanossian, Nerses; Liebeskind, David S; Kim, Doojin; Ali, Latisha K; Pineda, Sandra; Saver, Jeffrey L.

doi:10.1159/000247602

Cited by 50 publications

(49 citation statements)

References 44 publications

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“…Stroke patients with CKD had worse functional outcomes than without CKD [2] . However, there are significant discrepancies be- tween our study results and some previous findings showing no association between CKD and functional outcome using the mRS during hospitalization [20,21] . Probably, the variation can be originated from the different measurements and follow-up duration.…”

Section: Discussioncontrasting

confidence: 99%

Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

Jang

Sohn²,

Lee³

et al. 2015

Neuroepidemiology

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Background: The aim of this study was to investigate whether chronic kidney disease (CKD) predicts the outcome of the Functional Independence Measure (FIM) and the Korean version of the modified Barthel Index (K-MBI) 6 months after stroke with adjustment for age, gender, education, smoking, drinking, obesity, hypertension, diabetes mellitus, dyslipidemia, the FIM or K-MBI at discharge and the National Institutes of Health Stroke Scale (NIHSS) score 7 days post stroke. Methods: This study is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation. The sample included 2,037 ischemic stroke patients aged 18 years or older. The FIM and K-MBI scores were assessed at discharge and at 6 months after the onset of stroke. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR <60 ml/min/1.73 m². Results: Overall, the mean age was 65.5 (±12.4) years. The proportion of men was 62.6%. The proportion of CKD cases was 12.7%. The means of the 6-month FIM and K-MBI were 109.8 (±27.9) and 87.0 (±26.4), respectively. In multiple linear regressions, the 6-month FIM after stroke was significantly associated with CKD (-2.85, p < 0.05), age (-0.29, p < 0.01), the FIM at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.71, p < 0.01). Additionally, the post-stroke 6-month K-MBI was significantly associated with CKD (-2.88, p < 0.01), age (-0.27, p < 0.01), the K-MBI at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.55, p < 0.01). Conclusions: This nationwide hospital-based cohort study showed that CKD might predict poor 6-month FIM and K-MBI scores in ischemic stroke patients.

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Section: Discussioncontrasting

confidence: 99%

Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

Jang

Sohn²,

Lee³

et al. 2015

Neuroepidemiology

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“…11,12,17,21, 22 The difference in study results may be attributed to variations in patient population, sample size and adjusted confounders. BUN is generally considered as being a less specific marker of kidney function than serum Cr and eGFR.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

You

Zheng

Zhong

et al. 2018

Circ J

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Background:Prior studies have shown an association between high blood urea nitrogen (BUN) and an elevated risk of mortality in heart failure patients, but data on the prognostic significance of BUN and other markers of kidney function in acute ischemic stroke (AIS) patients are sparse. Methods and Results:A total of 3,355 AIS patients were enrolled from December 2013 to May 2014, across 22 hospitals. Admission BUN was divided into quartiles (Q1, <4.39 mmol/L; Q2, ≥4.39 and <5.40 mmol/L; Q3, ≥5.40 and <6.70 mmol/L and Q4, ≥6.70 mmol/L) and estimated glomerular filtration rate (eGFR), creatinine (Cr) and BUN/Cr were also categorized. Cox proportional hazard and logistic regression models were used to estimate the effect of BUN, eGFR, Cr and BUN/Cr on all-cause in-hospital mortality and poor outcome on discharge (modified Rankin Scale score ≥3) in AIS patients. During hospitalization, 120 patients (3.6%) died from all causes and 1,287 (38.4%) had poor outcome at discharge. BUN was independently associated with all-cause in-hospital mortality (adjusted HR for Q4 vs. Q1, 3.75; 95% CI: 1.53-9.21; P-trend=0.003) but not poor outcome at discharge (P-trend=0.229). No significant association was found, however, between reduced eGFR, increased Cr and BUN/Cr and all-cause in-hospital mortality and poor outcome at discharge (all P-trend ≥0.169). Conclusions:Increased BUN at admission is a significant prognostic factor associated with in-hospital mortality in AIS patients, but not with poor discharge outcome.

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“…Furthermore, previous research also found that proteinuria, but not low eGFR, was associated with neurological deterioration or a poor functional prognosis after ischemic stroke. 14,15 Thus, there may be a discrepancy between the effects of proteinuria and low eGFR on the shortterm prognosis for ischemic stroke. …”

Section: Discussionmentioning

confidence: 99%

Impact of Albuminuria on Early Neurological Deterioration and Lesion Volume Expansion in Lenticulostriate Small Infarcts

Umemura

Senda

Fukami

et al. 2014

Stroke

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Recently, it has been noted that the hemodynamics of the vascular beds of the brain and the kidney are similar, and attention has been focused on the brain-kidney interaction. [6][7][8] Additionally, a similar vascular structure has been observed in the penetrating arteries of the brain and the juxtamedullary afferent arterioles of the kidney.7 Albuminuria, a marker of chronic kidney disease, is associated with an increased risk of incident stroke and unfavorable long-term outcomes. 9 Moreover, albuminuria may indicate vascular endothelial dysfunction, which leads to neuronal damage via blood-brain barrier impairment. In this study, we sought to explore whether albuminuria can be used to identify neurological deterioration and infarct volume expansion in patients with acute small subcortical infarcts in the LSA territory. Materials and MethodsThis retrospective study included consecutive patients with a diagnosis of single small subcortical infarcts localized in the LSA territory Background and Purpose-Albuminuria, a marker of chronic kidney disease, is associated with an increased risk of incident stroke and unfavorable long-term outcomes. However, the association of albuminuria with short-term outcomes and change in infarct volume in patients with acute small subcortical infarction remains unknown. Methods-We retrospectively reviewed 85 consecutive patients with acute small subcortical infarcts in the lenticulostriate artery territory who were admitted to our stroke center within 24 hours of symptom onset and underwent serial diffusionweighted imaging (DWI). Albuminuria was determined based on the urinary albumin-to-creatinine ratio obtained from a first morning spot urine after admission. Infarct volume was measured on axial sections of the initial and follow-up DWI. Early neurological deterioration (END) was defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale score during the first 5 days after admission. Results-Albuminuria (UACR ≥30 mg/g creatinine) was observed in 14 of 18 patients with END (77.8%) and in 25 of 67 patients without END (37.3%), P=0.002. Multivariate logistic regression analysis revealed that albuminuria was associated with END after adjustment for age, low estimated glomerular filtration rate (<60 mL/min per 1.73 m 2 ), and infarct volume on initial DWI (odds ratio, 6.64; 95% confidence interval, 1.62-27.21; P=0.009). In addition, albuminuria was an independent predictor of increase in infarct volume using multivariate linear regression analysis (β coefficient=0.217; P=0.038). Conclusions-Our findings suggest that albuminuria is associated with END and infarct volume expansion in patients with small subcortical infarcts in the lenticulostriate artery territory. (Stroke. 2014;45:587-590.)Key Words: albuminuria ◼ acute stroke ◼ diffusion-weighted imaging ◼ infarct volume ◼ lenticulostriate arteries Impact of Albuminuria on Early Neurological Deterioration and Lesion Volume Expansion in Lenticulostriate Small InfarctsToshitaka Umemura, MD, PhD; Joe Senda, MD,...

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Indices of Kidney Dysfunction and Discharge Outcomes in Hospitalized Stroke Patients without Known Renal Disease

Cited by 50 publications

References 44 publications

Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

Impact of Albuminuria on Early Neurological Deterioration and Lesion Volume Expansion in Lenticulostriate Small Infarcts

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