Smyth Andrew, Judge Conor, Wang Xingu, Pare Guillaume, Rangarajan Sumathy, Canavan Michelle, Chin Siu Lim, Al-Hussain Fawaz, Yusufali Afzalhussein M, Elsayed Ahmed, Damasceno Albertino, Avezum Alvaro, Czlonkowska Anna, Rosengren Annika, Dans Antonio L, Oguz Aytekin, Mondo Charles, Weimar Christian, Ryglewicz Danuta, Xavier Denis, Lanas Fernando, Malaga German, Hankey Graeme J, Iversen Helle K, Zhang Hongye, Yusoff Khalid, Pogosova Nana, Lopez-Jamarillo Patricio, Langhorne Peter, Diaz Rafael, Oveisgharan Shahram, Yusuf Salim, O'Donnell Martin
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland.
Neuroepidemiology. 2021;55(3):206-215. doi: 10.1159/000515239. Epub 2021 May 5.
Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association.
We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations.
INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke.
Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24-1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35-1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17-1.42) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50-3.54 for death within 1 month).
Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.
既往研究报道了肾功能损害与中风之间的关联，但这种关联存在不确定性。
我们探讨这种关联是由共同的危险因素所解释，还是独立存在的，以及是否存在地区或中风亚型差异。
INTERSTROKE是一项病例对照研究，也是关于首次急性中风危险因素的最大规模国际研究，在27个国家完成。我们纳入了有可用血清肌酐值的个体，并计算估计肾小球滤过率（eGFR）。肾功能损害定义为eGFR<60 mL/（min·1.73 m²）。采用多变量条件逻辑回归来确定肾功能与中风之间的关联。
在21,127名参与者中，41.0%为女性，平均年龄为62.3±13.4岁，平均eGFR为79.9±23.5 mL/（min·1.73 m²）。病例组中肾功能损害的患病率更高（22.9%对17.7%，p<0.001），且存在地区差异（p<0.001）。调整后，较低的eGFR与中风几率增加相关。肾功能损害与所有中风的几率增加相关（比值比1.35；95%置信区间：1.24 - 1.47），脑出血的几率（比值比1.60；95%置信区间：1.35 - 1.89）高于缺血性中风（比值比1.29；95%置信区间：1.17 - 1.42）（交互作用p值0.12）。在年轻参与者以及生活在非洲、南亚或南美洲的人群中观察到最大的关联程度（所有中风的交互作用p值<0.001）。肾功能损害还与较差的临床结局相关（1个月内死亡的相对风险降低率2.97；95%置信区间：2.50 - 3.54）。
肾功能损害是中风的重要危险因素，尤其是在年轻患者中，并且与更严重的中风及更差的结局相关。
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