Zhang Yin, Pan Yuesong, Yan Hongyi, Meng Xia, Lin Jinxi, Wang Mengxing, Li Hao, Xu Qin, Chen Pan, Wang Anxin, Zhou Yilun, Wang Yongjun
Department of Nephrology Beijing Tiantan Hospital, Capital Medical University Beijing China.
Department of Epidemiology and Health Statistics, School of Public Health Capital Medical University Beijing China.
J Am Heart Assoc. 2025 Jan 21;14(2):e037579. doi: 10.1161/JAHA.124.037579. Epub 2025 Jan 16.
The impact of long-term renal function change on stroke outcomes remains unclear. This study used the CNSR-III (Third China National Stroke Registry) cohort to determine whether changes in estimated glomerular filtration rate based on creatinine and cystatin C (eGFR) during the first year post stroke were associated with 5-year stroke outcomes.
We included 4270 patients with centrally tested serum creatinine and cystatin C at admission and 1 year post admission and evaluated 5-year follow-up data. Patients were stratified into quintiles based on the 1-year changes in eGFR. The primary outcomes included all-cause mortality, stroke disability, and stroke recurrence. In patients with acute ischemic stroke, the mean baseline eGFR was 88.6±22.6 mL/min per 1.73 m, which decreased by 5.6% to 83.6±20.7 mL/min per 1.73 m at 1 year. Compared with patients with relatively stable eGFR (Q3), those with decreased eGFR (Q1) exhibited significantly increased adjusted risk of death (hazard ratio [HR], 1.96 [95% CI, 1.27-3.04], =0.003) and those with increased eGFR (Q5) exhibited borderline significance (HR, 1.51 [95% CI, 0.94-2.42], =0.09), after adjusting for confounders, including baseline eGFR and albumin-to-creatinine ratio. Patients with a significant decrease (odds ratio [OR], 1.74 [95% CI, 1.25-2.42], =0.001) or increase (OR, 1.51 [95% CI, 1.06-2.15], =0.02) in eGFR also experienced a higher risk of disability.
Both the decline and increase in eGFR levels in the first year post stroke were independently associated with all-cause mortality and stroke disability. These findings indicate that monitoring eGFR changes could be important for predicting long-term outcomes and informing poststroke care strategies.
长期肾功能变化对卒中结局的影响仍不明确。本研究利用中国国家卒中登记数据库三期（CNSR-III）队列，以确定卒中后第一年基于肌酐和胱抑素C的估计肾小球滤过率（eGFR）变化是否与5年卒中结局相关。
我们纳入了4270例入院时及入院后1年进行了中心检测血清肌酐和胱抑素C的患者，并评估了5年随访数据。根据eGFR的1年变化将患者分为五分位数。主要结局包括全因死亡率、卒中残疾和卒中复发。在急性缺血性卒中患者中，平均基线eGFR为每1.73平方米88.6±22.6毫升/分钟，1年时降至每1.73平方米83.6±20.7毫升/分钟，下降了5.6%。与eGFR相对稳定的患者（Q3）相比，eGFR降低的患者（Q1）在调整包括基线eGFR和白蛋白与肌酐比值等混杂因素后，死亡调整风险显著增加（风险比[HR]，1.96[95%置信区间，1.27 - 3.04]，P = 0.003），而eGFR升高的患者（Q5）具有临界显著性（HR，1.51[95%置信区间，0.94 - 2.42]，P = 0.09）。eGFR显著降低（比值比[OR]，1.74[95%置信区间，1.25 - 2.42]，P = 0.001）或升高（OR，1.51[95%置信区间，1.06 - 2.15]，P = 0.02）的患者残疾风险也更高。
卒中后第一年eGFR水平的下降和升高均与全因死亡率和卒中残疾独立相关。这些发现表明，监测eGFR变化对于预测长期结局和指导卒中后护理策略可能很重要。
