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Proteinuria Is an Independent Risk Factor for First Incident Stroke in Adults Under Treatment for Hypertension in

Chunyan Zhang1, Xiaobin Wang2, Mingli He3

  • 1National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).

Journal of the American Heart Association
|December 20, 2015
PubMed

Insights

Proteinuria, but not reduced estimated glomerular filtration rate (eGFR), is an independent risk factor for stroke in hypertensive adults in China. This finding aids in identifying individuals at higher risk for stroke.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Epidemiology

Background:

  • Conflicting evidence exists on whether reduced estimated glomerular filtration rate (eGFR) and proteinuria independently predict stroke in hypertensive patients.
  • This study aimed to clarify the association of these renal markers with first incident stroke in Chinese adults undergoing hypertension treatment.

Purpose of the Study:

  • To investigate the independent association of baseline estimated glomerular filtration rate (eGFR) and proteinuria with the risk of first incident stroke.
  • To determine if proteinuria or reduced eGFR are significant risk factors for stroke subtypes in hypertensive individuals.

Main Methods:

  • The China Stroke Primary Prevention Trial cohort, comprising 19,599 adults aged 45-75 years, was analyzed.
  • Baseline eGFR was calculated using the CKD-EPI creatinine equation; proteinuria was assessed via dipstick urinalysis and quantitative albumin-creatinine ratio in a subset.
  • Cox regression analysis was employed to evaluate the impact of eGFR and proteinuria on first stroke risk over a median follow-up of 4.5 years.

Main Results:

  • A total of 585 first strokes, including 472 ischemic strokes, were recorded during follow-up.
  • Participants with proteinuria (dipstick trace or higher) exhibited a 35% increased risk of first stroke (adjusted HR: 1.35; 95% CI: 1.09-1.66).
  • Reduced eGFR was not significantly associated with stroke risk, either independently or when combined with proteinuria analyses.

Conclusions:

  • Baseline proteinuria, detected by both dipstick and quantitative methods, is an independent predictor of first incident stroke and ischemic stroke in hypertensive adults in China.
  • Reduced estimated glomerular filtration rate (eGFR) was not identified as an independent risk factor for stroke in this population.
  • These findings highlight the importance of proteinuria screening in hypertensive patients for stroke risk stratification.
Abstract

Keywords:
Chinese hypertensive adultsalbumin–creatinine ratioestimated glomerular filtration ratefirst incident strokeproteinuria

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