Department of Medicine, Charles Drew University of Medicine and Science, USA.
J Neurol Sci. 2010 Jan 15;288(1-2):123-8. doi: 10.1016/j.jns.2009.09.020. Epub 2009 Oct 24.
Little is known about the long-term prognostic impact of baseline chronic kidney disease (CKD) on outcomes after stroke. We assessed the association of diagnosis and severity of baseline CKD with risk of mortality among persons with a history of stroke.
Data from the National Health and Nutrition Examination Survey (NHANES) a nationally representative sample of US adults were analyzed. The study population consisted of 425 individuals aged > or =55 years with a baseline history of stroke followed-up from NHANES III survey participation (1988-1994) through mortality assessment in 2000. CKD outcomes were glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) and urinary albumin to creatinine ratio (UACR) >30 mg/g of creatinine. CKD severity was categorized per national guidelines. Proportional hazard regression (Cox) was utilized to explore the independent relationship between CKD vs. all-cause and cardiovascular mortality after adjusting for confounders.
Among the cohort, 55.8% were female, 77.3% aged > or =65 years. Baseline serum creatinine was higher among persons with known stroke who later died vs. remained alive (p<0.01). Multivariable models showed that persons with low GFR (HR, 1.87 95% CI=1.30-2.68), CKD stages 1-2 (HR 1.84; 95% CI=1.06-3.20), 3 (HR 2.58; 95% CI=1.54-4.32), and 4-5 (HR 5.93; 95% CI=2.31-5.20) but not elevated UACR, had an independently higher relative hazard of death compared to individuals without these conditions. Similar results were seen with cardiovascular-specific mortality.
Baseline CKD, even of mild severity, is an independent predictor of future mortality among persons with known stroke.
关于基线慢性肾脏病（CKD）对中风后结局的长期预后影响，人们知之甚少。我们评估了基线 CKD 的诊断和严重程度与有中风病史的人群的死亡率风险之间的关系。
分析了来自国家健康和营养检查调查（NHANES）的美国成年人的全国代表性样本数据。该研究人群由 425 名年龄≥55 岁的个体组成，这些个体在 NHANES III 调查参与（1988-1994 年）时具有基线中风史，并通过 2000 年的死亡率评估进行随访。CKD 结局为肾小球滤过率（GFR）<60mL/min/1.73m²和尿白蛋白/肌酐比值（UACR）>30mg/g 肌酐。根据国家指南对 CKD 严重程度进行分类。利用比例风险回归（Cox）分析来探讨 CKD 与全因和心血管死亡率之间的独立关系，同时调整混杂因素。
在队列中，55.8%为女性，77.3%年龄≥65 岁。与存活者相比，已知患有中风且后来死亡的个体的基线血清肌酐更高（p<0.01）。多变量模型显示，GFR 较低的个体（HR，1.87；95%CI=1.30-2.68）、CKD 1-2 期（HR，1.84；95%CI=1.06-3.20）、3 期（HR，2.58；95%CI=1.54-4.32）和 4-5 期（HR，5.93；95%CI=2.31-5.20），但 UACR 升高者与无这些情况的个体相比，死亡的相对危险度更高。心血管特异性死亡率也出现了类似的结果。
基线 CKD，即使是轻度严重程度，也是已知中风患者未来死亡的独立预测因素。
