J Clin Neurol.  2015 Jan;11(1):73-79. 10.3988/jcn.2015.11.1.73.

A Low Baseline Glomerular Filtration Rate Predicts Poor Clinical Outcome at 3 Months after Acute Ischemic Stroke

• Kim HJ
• Kim JK
• Oh MS
• Kim SG
• Yu KH
• Lee BC

• KMID: 2179575
• DOI: http://doi.org/10.3988/jcn.2015.11.1.73

Abstract

BACKGROUND AND PURPOSE
Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study.
METHODS
This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): > or =60, 45-59, 30-44, and <30 mL/min/1.73 m2. The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score > or =3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of > or =4 at discharge compared to baseline) during hospitalization and in-hospital mortality.
RESULTS
The overall eGFR was 84.5+/-20.8 mL/min/1.73 m2 (mean+/-SD). The distribution of baseline renal impairment was as follows: 1,218, 82, 40, and 33 patients had eGFRs of > or =60, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively. At 3 months after the stroke, 476 (34.7%) patients exhibited poor functional outcome. Furthermore, a poor functional outcome occurred more frequently with increasingly advanced stages of CKD (rates of 31.9%, 53.7%, 55.0%, and 63.6% for CKD stages 1/2, 3a, 3b, and 4/5, respectively; p<0.001). Multivariate analysis revealed that a baseline eGFR of <30 mL/min/1.73m2 increased the risk of a poor functional outcome by 2.37-fold (p=0.047). In addition, baseline renal dysfunction was closely associated with neurological deterioration during hospitalization and with in-hospital mortality.
CONCLUSIONS
A low baseline eGFR was strongly predictive of both poor functional outcome at 3 months after ischemic stroke and neurological deterioration/mortality during hospitalization.

Keyword

chronic kidney disease; functional outcome; mortality; stroke

MeSH Terms

Cardiovascular Diseases
Cohort Studies
Cooperative Behavior
Epidemiology
Glomerular Filtration Rate*
Hospital Mortality
Hospitalization
Humans
Mortality
Multivariate Analysis
National Institutes of Health (U.S.)
Prospective Studies
Renal Insufficiency, Chronic
Risk Factors
Stroke*

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