Frequency, severity and predictors of renal dysfunction in patients with cerebral stroke
Keywords:cerebral stroke, renal dysfunction, chronic kidney disease, glomerular filtration rate, prevention
Background. The purpose was to evaluate the frequency and severity of renal dysfunction in patients with cerebral stoke (CS) and to determine predictors of moderate or severe reduction in estimated glomerular filtration rate (eGFR). Material and methods. Data of 360 enrolled patients with a verified diagnosis of CS admitted in 2010–2018 at different CS phases were analyzed. Upon admission, blood creatinine levels were determined in all participants on the DiaSys respons®920 automatic analyzer, and their eGFR was calculated using the CKD-EPI formula. EGFR from 89 to 60 ml/min/1.73 m2 was considered mildly, and < 60 ml/min/1.73 m2 — moderately or severely decreased. Qualitative variables are shown as numbers and percentages, quantitative variables — using the median and interquartile range (IQR). Data analysis was performed using MedCalc® Statistical Software. Results. In the sample, 41.7 % of participants were women, the median age was 66 years (IQR 58–75), 301 (83.6 %) patients were diagnosed with ischemic stroke (IS), the median of the baseline National Institutes of Health Stroke Scale score was 10 (IQR 6–17). High frequency of major vascular risk factors was documented: 82.2 % of individuals had arterial hypertension (AH), 36.4 % — atrial fibrillation, 28.6 % — diabetes mellitus, 30.6 % were obese, 14.7 % were current smokers, 16.4 % had alcohol abuse, and 23.3 % had recurrent CS. Their eGFR varied from 11.1 to 174.7 ml/min/1.73 m2 (median 87.8, IQR 62.5–98.5). Reduced eGFR was found in 55.0 % of patients, including 32.2 % with mild and 22.8 % with moderate or severe reduction. There were no significant differences in eGFR in different types of CS, but eGFR reduction was more often observed in cardioembolic IS compared to atherothrombotic one: 63.2 and 47.9 %, respectively (p < 0.05). According to the results of multivariate analysis, the patient’s age (odds ratio (OR) 1.02; 95% confidence interval (CI) 1.00–1.05, on average for each additional year, p = 0.044), male sex (OR 5.2; 95% CI 2.7–9.9; p < 0.001) and a history of AH (OR 2.7; 95% CI 1.2–6.4; p = 0.022) were independent predictors of moderate or severe eGFR reduction. The model built on these three variables was adequate, but the area under the curve of 0.70 (95% CI 0.65–0.75) indicates a moderate correlation. Conclusions. More than half of CS patients have renal dysfunction, and in almost 1/4 of cases, there is a moderate or severe decrease in eGFR (stages 3–5 of chronic kidney disease). Since AH is a predictor of a moderate or severe renal dysfunction in patients with MI, better control of AH (primarily with renin-angiotensin system inhibitors) can be an effective strategy to prevent severe chronic kidney disease.
Institute for Health Metrics and Evaluation (IHME).Global Health Data Exchange (GHDx): GBD Results Tool. Available from: http://ghdx.healthdata.org/gbd-results-tool.
Langhorne P, O'Donnell MJ, Chin SL, et al. Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study. Lancet. 2018 May 19;391(10134):2019-2027. doi:10.1016/S0140-6736(18)30802-X.
Pandian JD, Kalkonde Y, Sebastian IA, Felix C, Urimubenshi G, Bosch J. Stroke systems of care in low-income and middle-income countries: challenges and opportunities. Lancet. 2020 Oct 31;396(10260):1443-1451. doi:10.1016/S0140-6736(20)31374-X.
Hanna RM, Ferrey A, Rhee CM, Kalantar-Zadeh K. Renal-Cerebral Pathophysiology: The Interplay Between Chronic Kidney Disease and Cerebrovascular Disease. J Stroke Cerebrovasc Dis. 2020 Nov 13:105461. doi: 10.1016/j.jstrokecerebrovasdis.2020.105461.
Kajitani N, Uchida HA, Suminoe I, et al. Chronic kidney disease is associated with carotid atherosclerosis and symptomatic ischaemic stroke. J Int Med Res. 2018 Sep;46(9):3873-3883. doi:10.1177/0300060518781619.
Grams ME, Yang W, Rebholz CM, et al. Risks of Adverse Events in Advanced CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2017 Sep;70(3):337-346. doi:10.1053/j.ajkd.2017.01.050.
Tsagalis G, Akrivos T, Alevizaki M, Manios E, Stamatellopoulos K, Laggouranis A, Vemmos KN. Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrol Dial Transplant. 2009 Jan;24(1):194-200. doi:10.1093/ndt/gfn471.
Masson P, Webster AC, Hong M, Turner R, Lindley RI, Craig JC. Chronic kidney disease and the risk of stroke: a systematic review and meta-analysis. Nephrol Dial Transplant. 2015 Jul;30(7):1162-1169. doi:10.1093/ndt/gfv009.
Pereg D, Rozenbaum Z, Vorobeichik D, et al. Prevalence and Significance of Unrecognized Renal Dysfunction in Patients with Stroke. Am J Med. 2016 Oct;129(10):1074-1081. doi:10.1016/j.amjmed.2016.05.003.
Rozenbaum Z, Leader A, Neuman Y, et al. Prevalence and Significance of Unrecognized Renal Dysfunction in Patients with Acute Coronary Syndrome. Am J Med. 2016 Feb;129(2):187-194. doi:10.1016/j.amjmed.2015.08.017.
Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med. 2018 Mar 20;168(6):422-430. doi:10.7326/M17-2640.
Bernhardt J, Hayward KS, Kwakkel G, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017 Jul;12(5):444-450. doi:10.1177/1747493017711816.
El Husseini N, Fonarow GC, Smith EE, Ju C, et al. Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. Stroke. 2018 Dec;49(12):2896-2903. doi:10.1161/STROKEAHA.118.022011.
Hayden D, McCarthy C, Akijian L, et al. Renal dysfunction and chronic kidney disease in ischemic stroke and transient ischemic attack: A population-based study. Int J Stroke. 2017 Oct;12(7):761-769. doi:10.1177/1747493017701148.
Zorrilla-Vaca A, Ziai W, Connolly ES Jr, Geocadin R, Thompson R, Rivera-Lara L. Acute Kidney Injury Following Acute Ischemic Stroke and Intracerebral Hemorrhage: A Meta-Analysis of Prevalence Rate and Mortality Risk. Cerebrovasc Dis. 2018;45(1-2):1-9. doi:10.1159/000479338.
Herrington WG, Preiss D, Haynes R, et al. The potential for improving cardio-renal outcomes by sodium-glucose co-transporter-2 inhibition in people with chronic kidney disease: a rationale for the EMPA-KIDNEY study. Clin Kidney J. 2018 Dec;11(6):749-761. doi:10.1093/ckj/sfy090.
Khatri R, Afzal MR, Qureshi MA, Maud A, Huanyu D, Jose Rodriguez G. Pre-Existing Renal Failure Increases In-Hospital Mortality in Patients with Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis. 2019 Feb;28(2):237-242. doi:10.1016/j.jstrokecerebrovasdis.2018.07.036.
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