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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Renal dysfunction and chronic kidney disease in ischemic stroke and transient ischemic attack: A population-based
Derek Hayden1, Christine McCarthy1, Layan Akijian1
11 Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland.
Insights
Renal dysfunction and chronic kidney disease (CKD) are common in ischemic stroke and TIA patients, significantly increasing post-stroke mortality and poor functional outcomes. Further research is needed to explore potential modifiable mechanisms.
Area of Science:
- Nephrology
- Neurology
- Epidemiology
Background:
- The prevalence of chronic kidney disease (CKD) in ischemic stroke and transient ischemic attack (TIA) patients is not well-established.
- Previous studies on renal dysfunction and post-stroke outcomes are limited to hospitalized cohorts and have yielded conflicting results.
Purpose of the Study:
- To investigate the rates, determinants, and outcomes of renal dysfunction in ischemic stroke and TIA patients.
- To determine the prevalence of CKD by assessing the persistence of renal dysfunction in 90-day survivors.
Main Methods:
- Utilized the North Dublin Population Stroke Study data, including hot and cold pursuit ascertainment.
- Employed survival analysis using Kaplan-Meier curves and Cox proportional hazards modeling.
- Assessed renal dysfunction using estimated glomerular filtration rate (eGFR <60 mL/min per 1.73 m²).
Main Results:
- Renal dysfunction was observed in 44.6% of 547 patients; 31.2% of 90-day survivors met CKD criteria.
- An eGFR <45 mL/min per 1.73 m² independently predicted 28-day fatality (HR 2.53, p=0.01).
- Renal dysfunction predicted poor functional outcomes at two years (OR 2.17, p=0.04) and was associated with higher morbidity (52.5% vs. 20.6%, p<0.001).
Conclusions:
- Renal dysfunction and CKD are prevalent in ischemic stroke and TIA.
- Renal dysfunction is linked to significant post-stroke morbidity and mortality.
- Further research is warranted to explore potentially modifiable mechanisms underlying these associations.
Abstract:
Background and purpose The prevalence of chronic kidney disease (estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 for ≥3 months, chronic kidney disease (CKD)) in ischemic stroke and transient ischemic attack (TIA) is unknown, as estimates have been based on single-point estimates of renal function. Studies investigating the effect of renal dysfunction (eGFR < 60 mL/min per 1.73 m2, renal dysfunction) on post-stroke outcomes are limited to hospitalized cohorts and have provided conflicting results. Methods We investigated rates, determinants and outcomes of renal dysfunction in ischemic stroke and TIA in the North Dublin Population Stroke Study. We also investigate the persistence of renal dysfunction in 90-day survivors to determine the prevalence of CKD. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using Kaplan-Meier survival curves and Cox proportional hazards modeling. Results In 547 patients (ischemic stroke in 76.4%, TIA in 23.6%), the mean eGFR at presentation was 63.7 mL/min/1.73 m2 (SD 22.1). Renal dysfunction was observed in 44.6% (244/547). Among 90-day survivors, 31.2% (139/446) met criteria for CKD. After adjusting for age and stroke severity, eGFR < 45 mL/min/1.73 m2 (hazard ratio 2.53, p = 0.01) independently predicted 28-day fatality but not at two years. Poor post-stroke functional outcome (Modified Rankin Scale 3-5) at two years was more common in those with renal dysfunction (52.5% vs. 20.6%, p < 0.001). After adjusting for age, stroke severity and pre-stroke disability, renal dysfunction (OR 2.17, p = 0.04) predicted poor functional outcome. Conclusion Renal dysfunction and CKD are common in ischemic stroke and TIA. Renal dysfunction is associated with considerable post-stroke morbidity and mortality. Further studies are needed to investigate if modifiable mechanisms underlie these associations.
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