Abstract TMP54: Chronic Kidney Disease Does Not Influence Outcome After Acute Stroke
Background: Chronic kidney disease (CKD) is a risk factor for development of cardiovascular disease. Limited data describe the association between CKD and outcome following stroke, with contradictory results. One report has suggested that CKD may adversely affect outcome after thrombolysis, but was uncontrolled. We investigated the hypothesis that CKD adversely influences outcome following acute stroke and particularly after treatment with thrombolysis.
Methods: We extracted patient information from the Virtual International Stroke Trials Archive, including age, baseline severity, co-morbidities (diabetes and hypertension) and baseline serum creatinine. We estimated glomerular filtration rate (GFR) using the Modified Diet in Renal Disease equation. We used ordinal logistic regression to calculate odds ratios of poor outcome by modified Rankin Scale at 90 days comparing patients with normal versus abnormal renal function (GFR >90ml/min and <90ml/min respectively) as well as considering GFR as a continuous variable.
Results: Of 8605 patients with appropriate baseline data for analysis, those with normal renal function were younger [median (IQR): 64.0 (13.6) v. 71.7 (11.3) years respectively] but had comparable baseline severity [median NIHSS: 13.1 (5.6) v. 13.4 (5.8)]. When adjusted for age, baseline severity, stroke type, thrombolysis, diabetes and hypertension, there was no impact of GFR on outcome, neither in normal versus abnormal renal function (OR 1.00, 95% CI 0.92-1.09), nor with GFR expressed as a continuous variable (OR 1.007 per 10 ml/min, 95% CI 0.992-1.022). Outcomes in n=2594 after thrombolysis were unaffected by renal function.
Conclusion: CKD does not independently influence outcome following acute stroke, nor does it limit response to thrombolysis. Management of acute stroke need not differ in patients with CKD.
- © 2012 by American Heart Association, Inc.