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

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.