Abstract TMP93: Level of Renal Function and Short-term Risk of Recurrent Stroke
Introduction: Renal insufficiency is an established risk factor for first-time vascular events including stroke. There is a paucity of data on the relation of renal function to recurrent stroke risk, especially in a population-based setting. We evaluated the associations of different levels of renal function with short-term recurrent stroke risk.
Methods: Our cohort included patients admitted to 12 hospitals in a Northern California healthcare network with acute ischemic stroke between 2004 and 2007. Records from the index hospitalization and for 6 month follow ups were reviewed. Estimated Glomerular Filtration Rate (eGFR) in mL/min/1.73 m2, calculated using the MDRD equation, was categorized by modified National Kidney Foundation stage: 1 (≥90), 2(60-90), 3(30-60), 4 (<30). Multivariate analyses, using generalized estimating equations to adjust for within and between hospital variances, were adjusted for age, race, sex, hypertension, diabetes, and hyperlipidemia.
Results: Of 2,882 patients with eGFR, mean age was 73±13 ; 66% were Caucasian, 14% African-American, 11% Asian and 52% were female. On admission, renal function was stage 1 in 693 (24%), 2 in 1341 (47%), 3 in 706 (25%), and 4 in 142 (5%). An inverse relationship between age and eGFR was observed (p<0.001). African Americans were most likely to have stage 1 and stage 4 renal function (p<0.001) and Caucasians were more likely to have stage 2 and 3 renal function (p<0.001). Hypertension was most common among those with stage 3 renal function (p<0.001), and diabetes and hyperlipidemia were most common among those with stage 4 renal function (p<0.001 for both). In multivariate analysis, blood pressure control at 6 month follow up was less likely with stage 4 renal function compared with lower stages (OR 0.47, p<0.001), but there was no difference between stages 1, 2 and 3. There was a direct relationship between stage of renal function and risk of recurrent stroke (stage 1 REF, stage 2 OR 1.6, stage 3 OR 1.7, stage 4 OR 1.8, p<0.01 for all).
Conclusions: Decreased renal function is an independent predictor of short-term recurrent stroke in a graded dose-dependent manner. Even among those with “normal” renal function (eGFR 60-90), recurrent stroke risk was 60% greater than in those with higher eGFR.
- © 2012 by American Heart Association, Inc.