Frequency, severity and predictors of renal dysfunction in patients with cerebral stroke

Authors

  • Yu.V. Flomin Medical Center “Universal Clinic “Oberig”, Kyiv, Ukraine
  • D.D. Ivanov Bogomolets National Medical University of the Ministry of Health of Ukraine, Kyiv, Ukraine http://orcid.org/0000-0003-2609-0051
  • O.M. Chervonopyska Medical Center “Universal Clinic “Oberig”, Kyiv, Ukraine
  • V.G. Gurianov Shupyk National Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine, Kyiv, Ukraine
  • L.I. Sokolova Shupyk National Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2307-1257.9.4.2020.218553

Keywords:

cerebral stroke, renal dysfunction, chronic kidney di­sease, glomerular filtration rate, prevention

Abstract

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.

References

Campbell BCV, Khatri P. Stroke. Lancet. 2020 Jul 11;396(10244):129-142. doi:10.1016/S0140-6736(20)31179-X.

Institute for Health Metrics and Evaluation (IHME).Global Health Data Exchange (GHDx): GBD Results Tool. Available from: http://ghdx.healthdata.org/gbd-results-tool.

Kim J, Thayabaranathan T, Donnan GA, et al. Global Stroke Statistics 2019. Int J Stroke. 2020 Oct;15(8):819-838. doi:10.1177/1747493020909545.

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.

Lau WL, Nunes ACF, Vasilevko V, et al. Chronic Kidney Disease Increases Cerebral Microbleeds in Mouse and Man. Transl Stroke Res. 2020 Feb;11(1):122-134. doi:10.1007/s12975-019-00698-8.

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.

Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol. 2014 Aug;13(8):823-833. doi:10.1016/S1474-4422(14)70026-2.

Chelluboina B, Vemuganti R. Chronic kidney disease in the pathogenesis of acute ischemic stroke. J Cereb Blood Flow Metab. 2019 Oct;39(10):1893-1905. doi:10.1177/0271678X19866733.

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.

Ding WY, Lip GYH. Does Renal Function Predict Short- and Medium-Term Mortality and Hospital Readmissions in Poststroke Patients? Stroke. 2018 Dec;49(12):2812-2813. doi:10.1161/STROKEAHA.118.023723.

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.

Hao Z, Wu B, Lin S, et al. Association between renal function and clinical outcome in patients with acute stroke. Eur Neurol. 2010;63(4):237-242. doi:10.1159/000285165.

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.

Hill NR, Fatoba ST, Oke JL, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016 Jul 6;11(7):e0158765. doi:10.1371/journal.pone.0158765.

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.

Yahalom G, Schwartz R, Schwammenthal Y, et al. Chronic kidney disease and clinical outcome in patients with acute stroke. Stroke. 2009 Apr;40(4):1296-1303. doi:10.1161/STROKEAHA.108.520882.

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.

Published

2020-09-01

Issue

Section

Original Articles