Hayden Derek, McCarthy Christine, Akijian Layan, Callaly Elizabeth, Ní Chróinín Danielle, Horgan Gillian, Kyne Lorraine, Duggan Joseph, Dolan Eamon, O' Rourke Killian, Williams David, Murphy Sean, O'Meara Yvonne, Kelly Peter J
1 Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland.
2 Connolly Hospital Blanchardstown, Dublin, Ireland.
Int J Stroke. 2017 Oct;12(7):761-769. doi: 10.1177/1747493017701148. Epub 2017 Jun 23.
Background and purpose The prevalence of chronic kidney disease (estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m for ≥3 months, chronic kidney disease (CKD)) in ischemic stroke and transient ischemic attack (TIA) is unknown, as estimates have been based on single-point estimates of renal function. Studies investigating the effect of renal dysfunction (eGFR < 60 mL/min per 1.73 m, renal dysfunction) on post-stroke outcomes are limited to hospitalized cohorts and have provided conflicting results. Methods We investigated rates, determinants and outcomes of renal dysfunction in ischemic stroke and TIA in the North Dublin Population Stroke Study. We also investigate the persistence of renal dysfunction in 90-day survivors to determine the prevalence of CKD. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using Kaplan-Meier survival curves and Cox proportional hazards modeling. Results In 547 patients (ischemic stroke in 76.4%, TIA in 23.6%), the mean eGFR at presentation was 63.7 mL/min/1.73 m (SD 22.1). Renal dysfunction was observed in 44.6% (244/547). Among 90-day survivors, 31.2% (139/446) met criteria for CKD. After adjusting for age and stroke severity, eGFR < 45 mL/min/1.73 m (hazard ratio 2.53, p = 0.01) independently predicted 28-day fatality but not at two years. Poor post-stroke functional outcome (Modified Rankin Scale 3-5) at two years was more common in those with renal dysfunction (52.5% vs. 20.6%, p < 0.001). After adjusting for age, stroke severity and pre-stroke disability, renal dysfunction (OR 2.17, p = 0.04) predicted poor functional outcome. Conclusion Renal dysfunction and CKD are common in ischemic stroke and TIA. Renal dysfunction is associated with considerable post-stroke morbidity and mortality. Further studies are needed to investigate if modifiable mechanisms underlie these associations.
缺血性卒中和短暂性脑缺血发作（TIA）中慢性肾脏病（估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²持续≥3个月，即慢性肾脏病（CKD））的患病率尚不清楚，因为此前的估计均基于肾功能的单点评估。研究肾功能不全（eGFR<60 mL/min/1.73 m²，即肾功能不全）对卒中后结局影响的研究仅限于住院队列，且结果相互矛盾。方法：在北都柏林人群卒中研究中，我们调查了缺血性卒中和TIA患者肾功能不全的发生率、决定因素及结局。我们还研究了90天幸存者中肾功能不全的持续性，以确定CKD的患病率。通过使用多个重叠来源进行冷热追踪来确定病例。采用Kaplan-Meier生存曲线和Cox比例风险模型进行生存分析。结果：在547例患者中（76.4%为缺血性卒中，23.6%为TIA），就诊时的平均eGFR为63.7 mL/min/1.73 m²（标准差22.1）。44.6%（244/547）的患者存在肾功能不全。在90天幸存者中，31.2%（139/446）符合CKD标准。在调整年龄和卒中严重程度后，eGFR<45 mL/min/1.73 m²（风险比2.53，p=0.01）可独立预测28天死亡率，但不能预测两年死亡率。肾功能不全患者在两年时卒中后功能结局差（改良Rankin量表评分3 - 5分）更为常见（52.5%对20.6%，p<0.001）。在调整年龄、卒中严重程度和卒中前残疾情况后，肾功能不全（比值比2.17，p=0.04）可预测功能结局差。结论：肾功能不全和CKD在缺血性卒中和TIA中很常见。肾功能不全与卒中后相当高的发病率和死亡率相关。需要进一步研究以调查这些关联是否存在可改变的机制。
