Wang Xiao, Sin Chun-Fung, Teo Kay-Cheong, Leung William C Y, Wong Yuen-Kwun, Liu Roxanna K C, Fok Joshua W, Ip Bonaventure Y, Kwan Hon Hang, Lee Tsz Ching, Sheng Bun, Yip Edwin Kin-Keung, Yap Desmond Y H, Luo Hao, Lau Kui-Kai
Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Department of Pathology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Front Neurol. 2024 Apr 22;15:1294022. doi: 10.3389/fneur.2024.1294022. eCollection 2024.
Although renal dysfunction is associated with adverse clinical outcomes in patients with atrial fibrillation (AF) following stroke, the impact of renal function variability is unclear.
This study aimed to assess the association between renal function variability and various adverse clinical outcomes in patients with transient ischemic attack (TIA)/ischemic stroke and atrial fibrillation (AF).
We conducted a population-based study and retrospectively identified patients hospitalized with a diagnosis of TIA/ischemic stroke and AF during 2016-2020 using the Clinical Data Analysis and Reporting System of Hong Kong. Serial serum creatinine tested upon the onset of TIA/ischemic stroke and during their subsequent follow-up was collected. Renal function variability was calculated using the coefficient of variation of the estimated glomerular filtration rate (eGFR). Clinical endpoints that occurred during the study period were captured and included ischemic stroke/systemic embolism, intracerebral hemorrhage (ICH), total bleeding, major adverse cardiovascular events (MACE), cardiovascular, non-cardiovascular, and all-cause mortality. Competing risk regression and Cox proportional hazard regression models were used to assess the associations of renal function variability with the outcomes of interest.
A total of 3,809 patients (mean age 80 ± 10 years, 43% men) who satisfied the inclusion and exclusion criteria were followed up for a mean of 2.5 ± 1.5 years (9,523 patient-years). The mean eGFR was 66 ± 22 mL/min/1.73 m at baseline, and the median number of renal function tests per patient during the follow-up period was 20 (interquartile range 11-35). After accounting for potential confounders, a greater eGFR variability was associated with increased risks of recurrent ischemic stroke/systemic embolism [fully adjusted subdistribution hazard ratio 1.11, 95% confidence interval (CI) 1.03-1.20], ICH (1.17, 1.01-1.36), total bleeding (1.13, 1.06-1.21), MACE (1.22, 1.15-1.30), cardiovascular (1.49, 1.32-1.69), non-cardiovascular (1.43, 1.35-1.52), and all-cause mortality (fully adjusted hazard ratio 1.44, 1.39-1.50).
Visit-to-visit renal function variability is independently associated with adverse clinical outcomes in TIA/ischemic stroke patients with AF. Further large-scale studies are needed to validate our results.
尽管肾功能不全与房颤（AF）患者卒中后的不良临床结局相关，但肾功能变异性的影响尚不清楚。
本研究旨在评估短暂性脑缺血发作（TIA）/缺血性卒中合并房颤（AF）患者的肾功能变异性与各种不良临床结局之间的关联。
我们开展了一项基于人群的研究，利用香港临床数据分析与报告系统，回顾性确定2016年至2020年期间因TIA/缺血性卒中合并房颤而住院的患者。收集TIA/缺血性卒中发作时及其后续随访期间的系列血清肌酐检测结果。使用估计肾小球滤过率（eGFR）的变异系数计算肾功能变异性。记录研究期间发生的临床终点事件，包括缺血性卒中/系统性栓塞、脑出血（ICH）、总出血、主要不良心血管事件（MACE）、心血管、非心血管及全因死亡率。采用竞争风险回归和Cox比例风险回归模型评估肾功能变异性与感兴趣结局之间的关联。
共有3809例符合纳入和排除标准的患者（平均年龄80±10岁，43%为男性）接受了平均2.5±1.5年（9523患者年）的随访。基线时平均eGFR为66±22 mL/min/1.73 m²，随访期间每位患者肾功能检测的中位数为20次（四分位间距11 - 35）。在考虑潜在混杂因素后，更大的eGFR变异性与复发性缺血性卒中/系统性栓塞风险增加相关[完全调整后的亚分布风险比1.11，95%置信区间（CI）1.03 - 1.20]、脑出血（1.17，1.01 - 1.36）、总出血（1.13，1.06 - 1.21）、MACE（1.22，1.15 - 1.30）、心血管（1.49，1.32 - 1.69）、非心血管（1.43，1.35 - 1.52）及全因死亡率（完全调整后的风险比1.44，1.39 - 1.50）。
TIA/缺血性卒中合并房颤患者的每次就诊肾功能变异性与不良临床结局独立相关。需要进一步开展大规模研究来验证我们的结果。
