doi: 10.1161/01.STR.0000016344.49819.F7
(Stroke. 2002;33:1630.)
© 2002 American Heart Association, Inc.
Original Contributions |
Does Renal Dysfunction Predict Mortality After Acute Stroke?
A 7-Year Follow-Up Study
From the Department of Medicine (R.S.M., G.S., H.W.F.), Department of Clinical Pharmacology and Therapeutics (S.Y.S.W., K.Y.K.W.), Department of Biochemical Medicine (C.G.F.), Department of Epidemiology and Public Health (S.A.O.), and Cardiovascular Epidemiology Unit (R.C.), Ninewells Hospital and Medical School, Dundee, Scotland, and Department of Physical Medicine and Rehabilitation, Inonu University Faculty of Medicine, Turgut Ozal Medical Centre, Malatya, Turkey (Y.E.).
Correspondence to Dr R.S. MacWalter, Consultant Physician, Stroke Studies Centre, Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland DD1 9SY. E-mail ronald.macwalter{at}tuht.scot.nhs.uk
Background and Purpose— The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke.
Methods— This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality.
Results— The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine <124 µmol/L. The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance 
51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine 119 µmol/L "relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92", urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or 9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine 0.08573 mmol/µmol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders.
Conclusions— After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.
Key Words: cerebrovascular disorders • creatinine • kidney function tests • mortality • prognosis • renal disease, end-stage • stroke • urea
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