Pre-stroke loop diuretics and anemia in elderly patients were associated with severe renal dysfunction at the onset of acute stroke

Abstract

Introduction: Severe renal dysfunction (SRD) is a common complication of chronic kidney disease (CKD) that is a risk of heart disease and acute stroke (AS). Furthermore, SRD can also limit the treatment options for AS patients and worsen their prognosis. Thus, preventing CKD progression to SRD and identifying the factors contributing to SRD at AS onset is crucial. However, the frequency of SRD in AS patients and the associated factors are poorly understood in different genders. In this study, we aimed to investigate the frequency of SRD in AS patients and analyze the associated factors by sex. Methods: Our cross-sectional study included patients who met the following criteria: 1) admission within 24 hours of AS onset between 2013 and 2019 and 2) availability of pre-stroke medication information. We used the Cockcroft-Gault equation for calculating creatinine clearance (Ccr) and defined SRD as Ccr <30 ml/min. Then, we performed a multivariable logistic regression analysis to identify independent factors associated with SRD on admission separately for males and females. Results: Out of 4294 patients with AS, 3472 were included for analysis. Of these, 1905 (54.9%) were male, with a median age of 75 and 81 years for males and females, respectively. The prevalence of SRD was 9.7% in males and 18.7% in females. For males, factors associated with SRD were loop diuretics, aspirin, L-type calcium channel blockers, alpha-beta blockers, and anemia. For females, factors associated with SRD were loop diuretics, mineralocorticoid receptor antagonists, and anemia. Conclusions: Loop diuretic use and anemia before AS onset were associated with SRD in both males and females. To prevent SRD, individualized drug and anemia management are essential. Further prospective studies are warranted to confirm our findings and to elucidate the causal mechanism of SRD in patients with AS.