Abstract
Background: Relationship of estimated glomerular filtration rate (eGFR) with complications after stroke has not been fully characterized for entire clinical spectrum of eGFR and for the fluctuation in eGFR during hospital stay.
Methods: Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 was analysed. eGFR was categorized into six clinically relevant categories as per Kidney Disease Improving Global Outcomes guidelines. Change in eGFR during acute admission was categorized into: within 5% change (ref.), 5-20% decline, >20% decline, 5-20% increase and >20% increase. All-cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest.
Results: 10,329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30,126 person years). Multivariable adjusted hazard ratios (HRs) (95%CI) for all-cause mortality were 0.91 (0.80-1.04), 0.96 (0.83-1.11), 1.23 (1.06-1.43), 1.54 (1.31-1.82) and 2.38 (1.91-2.97) for eGFR levels 60-89, 45-59, 30-44, 15-29 and <15 respectively, compared to eGFR ≥90 mL/min/1.73m2. The HR (95%CI) for eGFR change were 1.56 (1.36-1.79), 1.17 (1.05-1.30), 1.47 (1.32-1.62) and 1.71 (1.55-1.88) for >20% decline, 5-20% decline, 5-20% increase and >20 % increase, respectively, compared to change within 5%. Results were similar for other outcomes except recurrent stroke.
Conclusions: Stroke patients with eGFR <45 mL/min/1.73m2 at hospital admission and > 5% decline or increase in eGFR during hospital stay were at substantially high risk of poor outcomes, particularly all-cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.
Methods: Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 was analysed. eGFR was categorized into six clinically relevant categories as per Kidney Disease Improving Global Outcomes guidelines. Change in eGFR during acute admission was categorized into: within 5% change (ref.), 5-20% decline, >20% decline, 5-20% increase and >20% increase. All-cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest.
Results: 10,329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30,126 person years). Multivariable adjusted hazard ratios (HRs) (95%CI) for all-cause mortality were 0.91 (0.80-1.04), 0.96 (0.83-1.11), 1.23 (1.06-1.43), 1.54 (1.31-1.82) and 2.38 (1.91-2.97) for eGFR levels 60-89, 45-59, 30-44, 15-29 and <15 respectively, compared to eGFR ≥90 mL/min/1.73m2. The HR (95%CI) for eGFR change were 1.56 (1.36-1.79), 1.17 (1.05-1.30), 1.47 (1.32-1.62) and 1.71 (1.55-1.88) for >20% decline, 5-20% decline, 5-20% increase and >20 % increase, respectively, compared to change within 5%. Results were similar for other outcomes except recurrent stroke.
Conclusions: Stroke patients with eGFR <45 mL/min/1.73m2 at hospital admission and > 5% decline or increase in eGFR during hospital stay were at substantially high risk of poor outcomes, particularly all-cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.
Original language | English |
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Pages (from-to) | 1455-1463 |
Number of pages | 9 |
Journal | European Journal of Neurology |
Volume | 26 |
Issue number | 12 |
Early online date | 17 Jul 2019 |
DOIs | |
Publication status | Published - Dec 2019 |
Bibliographical note
We thank the data team of the Norfolk and Norwich University Hospital Stroke Services.Keywords
- eGFR
- stroke
- prognosis
- mortality
- disability
- all-cause
- chronic kidney-disease
- EGFR
- MORTALITY
- ALL-CAUSE
- CHRONIC KIDNEY-DISEASE
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Phyo Myint, Clinical Chair in Medicine of Old Age
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic