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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.ND

Abstract

BACKGROUND

Acute stroke is the third leading cause of death in western societies after ischemic heart disease and cancer. Although it is an emergency disease sharing the same atherosclerotic risk factors with ischemic heart disease, the association of renal function and stroke is poorly investigated. The present study aims at assessing renal function status in patients with acute stroke and investigate any prognostic significance on the outcome.

METHODS

This is a prospective study of hospitalized first-ever stroke patients over 10 years. The study population comprised 1350 patients admitted within 24 h from stroke onset and followed up for 1 to 120 months or until death. Patients were divided in 3 groups on the basis of the estimated Glomerular Filtration Rate (eGFR) that was calculated from the abbreviated equation of the Modification Diet for Renal Disease in ml/min/1.73 m(2) of body surface area: Group-A comprised patients who had eGFR > 60, group-B those with 30 <or= eGFR <or= 60 and group-C patients with eGFR < 30. Patients with Acute Kidney Injury (AKI) were excluded from the study. The main outcome measures were overall mortality and the composite new cardiovascular events (myocardial infarction, recurrent stroke, vascular death) among the 3 groups during the follow-up period.

RESULTS

Almost 1/3 (28.08%) of our acute stroke patients presented with moderate (group B) or severe (group C) renal dysfunction as estimated by eGFR. After adjusting for basic demographic, stroke risk factors and stroke severity on admission, eGFR was an independent predictor of stroke mortality at 10 years. Patients in groups B and C had an increased probability of death during follow-up: Hazard ratio = 1.21 with 95% CI 1.01-1.46, p < 0.05 and Hazard ratio = 1.76 with 95% CI 1.14-2.73, p < 0.05 respectively, compared to patients belonging to group A. The probability of death from any cause was significantly different among groups (log rank test 55.4, p = 0.001) during the follow-up period: in group-A patients it was 62.8 (95% CI 57.6-68.1), in group-B 77.3 (95% CI 68.5-86.1) and in group-C 89.2 (95% CI 75.1-100). During the follow-up period 336 new cardiovascular events occurred. The probability to have a new composite cardiovascular event was also significantly different among the 3 groups (log rank test 21.1, p = 0.001): in group-A patients it was 45.2 (95% CI 38.7-51.7), in group-B 67.4 (95% CI 56.2-78.6) and in group-C 77.6 (95% CI 53.5-100).

CONCLUSION

Renal function on admission appears to be a significant independent prognostic factor for long term mortality and new cardiovascular morbidity over a 10-year period.

Authors+Show Affiliations

1Renal Unit, Alexandra Hospital, University of Athens, Athens, Greece. tsagalis@otenet.grNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18728156

Citation

Tsagalis, George, et al. "Renal Dysfunction in Acute Stroke: an Independent Predictor of Long-term All Combined Vascular Events and Overall Mortality." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 24, no. 1, 2009, pp. 194-200.
Tsagalis G, Akrivos T, Alevizaki M, et al. Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrol Dial Transplant. 2009;24(1):194-200.
Tsagalis, G., Akrivos, T., Alevizaki, M., Manios, E., Stamatellopoulos, K., Laggouranis, A., & Vemmos, K. N. (2009). Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 24(1), 194-200. https://doi.org/10.1093/ndt/gfn471
Tsagalis G, et al. Renal Dysfunction in Acute Stroke: an Independent Predictor of Long-term All Combined Vascular Events and Overall Mortality. Nephrol Dial Transplant. 2009;24(1):194-200. PubMed PMID: 18728156.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. AU - Tsagalis,George, AU - Akrivos,Theodore, AU - Alevizaki,Maria, AU - Manios,Efstathios, AU - Stamatellopoulos,Kimon, AU - Laggouranis,Antonis, AU - Vemmos,Konstantinos N, Y1 - 2008/08/26/ PY - 2008/8/30/pubmed PY - 2009/2/28/medline PY - 2008/8/30/entrez SP - 194 EP - 200 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 24 IS - 1 N2 - BACKGROUND: Acute stroke is the third leading cause of death in western societies after ischemic heart disease and cancer. Although it is an emergency disease sharing the same atherosclerotic risk factors with ischemic heart disease, the association of renal function and stroke is poorly investigated. The present study aims at assessing renal function status in patients with acute stroke and investigate any prognostic significance on the outcome. METHODS: This is a prospective study of hospitalized first-ever stroke patients over 10 years. The study population comprised 1350 patients admitted within 24 h from stroke onset and followed up for 1 to 120 months or until death. Patients were divided in 3 groups on the basis of the estimated Glomerular Filtration Rate (eGFR) that was calculated from the abbreviated equation of the Modification Diet for Renal Disease in ml/min/1.73 m(2) of body surface area: Group-A comprised patients who had eGFR > 60, group-B those with 30 <or= eGFR <or= 60 and group-C patients with eGFR < 30. Patients with Acute Kidney Injury (AKI) were excluded from the study. The main outcome measures were overall mortality and the composite new cardiovascular events (myocardial infarction, recurrent stroke, vascular death) among the 3 groups during the follow-up period. RESULTS: Almost 1/3 (28.08%) of our acute stroke patients presented with moderate (group B) or severe (group C) renal dysfunction as estimated by eGFR. After adjusting for basic demographic, stroke risk factors and stroke severity on admission, eGFR was an independent predictor of stroke mortality at 10 years. Patients in groups B and C had an increased probability of death during follow-up: Hazard ratio = 1.21 with 95% CI 1.01-1.46, p < 0.05 and Hazard ratio = 1.76 with 95% CI 1.14-2.73, p < 0.05 respectively, compared to patients belonging to group A. The probability of death from any cause was significantly different among groups (log rank test 55.4, p = 0.001) during the follow-up period: in group-A patients it was 62.8 (95% CI 57.6-68.1), in group-B 77.3 (95% CI 68.5-86.1) and in group-C 89.2 (95% CI 75.1-100). During the follow-up period 336 new cardiovascular events occurred. The probability to have a new composite cardiovascular event was also significantly different among the 3 groups (log rank test 21.1, p = 0.001): in group-A patients it was 45.2 (95% CI 38.7-51.7), in group-B 67.4 (95% CI 56.2-78.6) and in group-C 77.6 (95% CI 53.5-100). CONCLUSION: Renal function on admission appears to be a significant independent prognostic factor for long term mortality and new cardiovascular morbidity over a 10-year period. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/18728156/Renal_dysfunction_in_acute_stroke:_an_independent_predictor_of_long_term_all_combined_vascular_events_and_overall_mortality_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfn471 DB - PRIME DP - Unbound Medicine ER -