Abstract 2872: Should Recent Stroke Patients be Routinely Screened for Kidney Disease?
Background: Since chronic kidney disease is a risk factor for the progression of cardiovascular disease, as well as recurrent cardiovascular events, a 2006 AHA Science Advisory recommends that all patients with cardiovascular disease be screened for evidence of kidney disease. Although several studies have related CKD as defined by a low estimated glomerular filtration rate (eGFR) to increased primary stroke risk, no studies have so far assessed the association of low eGFR with secondary vascular risk after stroke.
Objective: To evaluate the role of baseline low eGFR as an independent predictor of vascular risk after occurrence of an index ischemic stroke.
Methods: Observational analysis of multicenter trial data comprising recent ischemic stroke patients enrolled from September 1996 to May 2003 and followed for 2 years. Low GFR was defined as GFR < 60 mL/min per 1.73m2. We assessed the prevalence of high FCRS among only among subjects without known CHD. Association between baseline vascular risk factors and low eGFR were assessed using multivariable logistic regression. Cox models with and without competing risks were used to determine the relationship between low eGFR and outcome. The primary outcome was time to first stroke, myocardial infarction, or vascular death, and secondary outcome was time to first stroke.
Results: Of 3673 subjects (99.8% of cohort) who with complete data, 34.3% had low eGFR. Subjects with low eGFR were significantly more likely to be female, of White race, older, have a history of prior stroke, CHF, diabetes, MI, hypertension, coronary bypass surgery or coronary angioplasty, as well as higher baseline systolic BP, total cholesterol and triglycerides compared to subjects with normal eGFR. On the other hand, subjects with low eGFR were significantly less likely to drink, smoke, or use antithrombotics at baseline compared to subjects with normal eGFR. In unadjusted analyses, low eGFR (vs normal eGFR) was associated with higher rate of the primary (HR=1.77, 95% CI: 1.48-2.13, p<0.001) and secondary (HR=1.35, 95% CI: 1.08-1.70, p=0.01) outcomes. After adjusting for confounders, low GFR was related to the primary outcome (HR=1.54, 95% CI: 1.27-1.86, p<0.001) but its association with the secondary outcome did not reach significance (HR=1.26, 0.90-1.78, p=0.179). There were no significant interactions between low eGFR and any of the covariates in predicting outcome.
Conclusions: Baseline CKD is independently associated with a higher risk of secondary vascular events over 2 years among patients with a recent ischemic stroke. Consideration should be given to routinely screening all recent ischemic stroke patients for CKD. For those stroke patients with CKD, frequency of vascular events and progression of CKD might be ameliorated by prompt and appropriate intervention.
- © 2012 by American Heart Association, Inc.