The Association between Glomerular Filtration Rate Estimated on Admission and Acute Stroke Outcome: The Shiga Stroke Registry

Abstract

Aim: Although renal dysfunction has been identified as a novel risk factor affecting stroke prognosis, few have analyzed the association within large-scale population-based setting, using wide-range estimated glomerular filtration rate (eGFR) category. We aimed to determine the association of admission eGFR with acute stroke outcomes using data from a registry established in Shiga Prefecture, Japan.Methods: Following exclusion of patients younger than 18 years, with missing serum creatinine data, and with onset more than 7 days prior to admission, 2,813 acute stroke patients registered in the Shiga Stroke Registry year 2011 were included in the final analysis. The Japanese Society of Nephrology equation was used to estimate GFR. Multivariable logistic regression was performed to analyze the association of eGFR with all-cause in-hospital death (modified Rankin Scale [mRS] 6), and atdischarge death/disability (mRS 2–6). Separate analyses were conducted within stroke subtypes.Results: Compared to eGFR 60–89 mL/min/1.73 m2, adjusted odds ratios (ORs) and 95% confidence interval [95% CI] for in-hospital death (in the order of eGFR < 45, 45–59, and ≥ 90 mL/min/1.73 m2) were 1.54 [1.04–2.27], 1.07 [0.72–1.58], and 1.04 [0.67–1.59]. Likewise, adjusted ORs [95% CI] for at-discharge death/disability were 1.54 [1.02–2.32], 0.97 [0.73–1.31], and 1.48 [1.06–2.05]. Similar pattern was further evident in the eGFR < 45 mL/min/1.73 m2 group for both outcomes within acute ischemic stroke patients.Conclusions: Our study has ascertained that in acute stroke, particularly ischemic stroke, low eGFR was significantly associated with in-hospital death and at-discharge death/disability. Additionally, high eGFR was found to be associated with at-discharge death/disability.

Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study

“…CKD is an independent risk factor of cardiovascular disease [3]. For stroke patients, some studies suggested that CKD with decreased estimated glomerular filtration rate (eGFR) significantly increased the risk of stroke mortality [4,5]. In intravenous thrombolysis (IVT) therapy, one study with large sample size revealed that low GFR was independently associated with poor outcome and the risk of symptomatic intracerebral hemorrhage (sICH) [6].…”

The Risk for Incident Ischemic Heart Disease According to Estimated Glomerular Filtration Rate in A Korean Population

“…In a cross-sectional study, 2,308 Chinese subjects with an eGFR of 60-89 and 30-59 tended to have more cardiovascular risk factors and a higher prevalence of CVD than individuals with an eGFR 90 4) . An analysis of 2,813 patients with acute stroke indicated the significant association between reduced renal function and hospital death, in which adjusted odds ratios and 95% CIs for in-hospital death were 1.54 (1.04-2.27) when the eGFR 45, 1.07 (0.72-1.58) when the eGFR was 45-59, and 1.04 (0.67-1.59) when the eGFR ≥ 90 5) . In a 4.6-year longitudinal observation of 70 asymptomatic Japanese participants without CKD, median values of coronary artery calcium score and abdominal aortic calcification index increased from 40.2 to 113.3 and from 13.2% to 21.7%, respectively 6) .…”

“…However, these studies have some limitations. The cross-sectional study design limits the ability to identify the causative relationship between factors 4,5,7) , and the small number of study subjects has the weakness in generalizing the findings 6) . In contrast, we monitored the incident IHD for an average follow-up period of 4.35 0.55 years based on the ICD code of IHD registered in hospitals where patients were actually treated.…”

“…Thus, individuals with an eGFR 60-89 are regarded to be free from CKD as long as they have no evidence of kidney damage, such as proteinuria. Previous studies have indicated that reduced renal function with an eGFR 60 was significantly associated with an increased cardiovascular risk and mortality in an Asian population [4][5][6][7] . However, it is unclear whether a mildly decreased renal function (an eGFR of 60-89) is independently associated with an increased risk of cardiovascular disease (CVD).…”

“…Sung Keun Park 1 , Min-Ho Kim 2 , Eunhee Ha 3 , Ju Young Jung 1 , Chang-Mo Oh 4 , Joong-Myung Choi 4 , Hee Yong Kang 5 , Yong-Sung Choi 6 , Min Gi Kim 7 , Jung-Wook Kim 8 and Jae-Hong Ryoo 9 Participants and Methods…”