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Association between reduced kidney function and clinical outcomes after ischaemic stroke with atrial fibrillation
1Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Reduced kidney function in atrial fibrillation (AF) patients with ischemic stroke increases the risk of death but not stroke recurrence. This highlights the importance of renal function assessment in AF stroke management.
Area of Science:
- Cardiology
- Nephrology
- Neurology
Background:
- Atrial fibrillation (AF) is a major cause of cardioembolic stroke.
- Chronic kidney disease may worsen AF outcomes.
- The impact of reduced renal function on stroke patients with AF in China is understudied.
Purpose of the Study:
- To investigate the influence of reduced renal function on death, disability, and stroke recurrence.
- To compare outcomes in ischemic stroke patients with AF based on estimated glomerular filtration rate (eGFR).
Main Methods:
- Prospective study of 229 ischemic stroke patients with AF.
- Patients classified by reduced eGFR or normal eGFR.
- Comparison of clinical characteristics, functional outcomes, and stroke recurrence.
Main Results:
- 45.9% of patients had reduced eGFR.
- Reduced eGFR was associated with higher risk of death at 3, 6, and 12 months (adjusted).
- No significant difference in 1-year cumulative stroke recurrence between groups.
Conclusions:
- Reduced eGFR is an independent risk factor for increased mortality in ischemic stroke patients with AF.
- Further research in larger cohorts is needed to explore the link between reduced eGFR and stroke recurrence risk.
Background And Purpose:
Atrial fibrillation (AF) can cause up to 50% of cardioembolic strokes and its effects may be exacerbated by chronic kidney disease. Our aim was to investigate the influence of reduced renal function on death, disability and stroke recurrence in stroke patients with AF in China.
Methods:
In this prospective study, patients with ischaemic stroke and AF who were admitted within 1 month of stroke onset between January 2003 and February 2007 were consecutively enrolled. Patients were classified as having a reduced estimated glomerular filtration rate (eGFR) or normal eGFR, and clinical characteristics, functional outcomes and stroke recurrence were compared between the two groups.
Results:
A total of 229 patients were analyzed in the study, of whom 105 (45.9%) had reduced eGFR. These patients were more likely to be female, non-smokers and non-drinkers than were patients in the normal eGFR group (all P ≤ 0.002). Patients with reduced eGFR showed approximately 2-fold higher risk of death at 3, 6 and 12 months after stroke onset than did patients with normal eGFR (all P ≤ 0.042), after adjusting for age, sex and stroke severity on admission. However, the two groups showed similar 1-year cumulative stroke recurrence (P = 0.331, log rank test).
Conclusions:
Reduced eGFR was independently associated with increased risk of death in patients with ischaemic stroke and AF. The association between reduced eGFR and risk of stroke recurrence needs to be explored in larger studies.
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