Lee Jiann-Der, Kuo Ya-Wen, Lee Chuan-Pin, Huang Yen-Chu, Lee Meng, Lee Tsong-Hai
Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Clin Kidney J. 2024 Nov 30;18(1):sfae387. doi: 10.1093/ckj/sfae387. eCollection 2025 Jan.
Resting heart rate is a potent predictor of various renal outcomes. However, the decline rate of renal function in ischemic stroke patients is not well defined. We tested the association of heart rate with estimated eGFR decline and the composite renal outcomes in patients with recent ischemic stroke.
The data of 9366 patients with ischemic stroke with an eGFR of ≥30 mL/min/1.73 m were retrieved from the Chang Gung Research Database. Mean initial in-hospital heart rates were averaged and categorized into 10-beats-per-minute (bpm) increments. The outcomes were the annualized change in eGFR across the heart rate subgroups and composite renal outcomes, namely a ≥40% sustained decline in eGFR, end-stage renal disease, or renal death. Generalized estimating equation models were used to determine the annualized change in eGFR and Cox proportional hazards regression models were used to estimate the relative hazard of composite renal outcomes by referencing the subgroup with a heart rate of <60 bpm.
The annual eGFR decline in the patients with a mean heart rate of <60, 60-69, 70-79, 80-89, and ≥90 bpm was 2.12, 2.49, 2.83, 3.35, and 3.90 mL/min/1.73 m, respectively. Compared with the reference group, the adjusted hazard ratios for composite renal outcomes were 1.17 [95% confidence interval (CI), 0.89-1.53), 1.54 (95% CI, 1.19-2.00), 1.72 (95% CI, 1.30-2.28), and 1.84 (95% CI, 1.29-2.54] for the patients with a heart rate of 60-69, 70-79, 80-89, and ≥90 bpm, respectively. In the subgroup analysis, the associations between higher heart rate and both eGFR decline and composite renal outcomes were more evident and statistically significant in patients without atrial fibrillation.
A higher heart rate is associated with a faster rate of eGFR decline and an increased risk of composite renal outcomes after ischemic stroke, particularly in patients without atrial fibrillation. These results underscore the importance of heart rate monitoring and management in ischemic stroke patients in sinus rhythm to potentially mitigate renal function decline. Further studies are needed to explore this relationship in patients with atrial fibrillation and across different ethnic groups.
静息心率是多种肾脏结局的有力预测指标。然而，缺血性中风患者肾功能的下降速率尚未明确界定。我们检验了心率与估算的肾小球滤过率（eGFR）下降以及近期缺血性中风患者的复合肾脏结局之间的关联。
从长庚研究数据库中检索了9366例eGFR≥30 mL/min/1.73 m²的缺血性中风患者的数据。计算平均初始住院心率，并按每分钟10次心跳（bpm）的增量进行分类。结局指标为各心率亚组中eGFR的年化变化以及复合肾脏结局，即eGFR持续下降≥40%、终末期肾病或肾脏死亡。使用广义估计方程模型确定eGFR的年化变化，使用Cox比例风险回归模型通过参照心率<60 bpm的亚组来估计复合肾脏结局的相对风险。
平均心率<60、60 - 69、70 - 79、80 - 89和≥90 bpm的患者，其eGFR的年下降率分别为2.12、2.49、2.83、3.35和3.90 mL/min/1.73 m²。与参照组相比，心率为60 - 69、70 - 79、80 - 89和≥90 bpm的患者，复合肾脏结局的校正风险比分别为1.17 [95%置信区间（CI），0.89 - 1.53]、1.54（95% CI，1.19 - 2.00）、1.72（95% CI，1.30 - 2.28）和1.84（95% CI，1.29 - 2.54）。在亚组分析中，较高心率与eGFR下降和复合肾脏结局之间的关联在无房颤的患者中更为明显且具有统计学意义。
较高心率与缺血性中风后eGFR下降速率加快以及复合肾脏结局风险增加相关，尤其是在无房颤的患者中。这些结果强调了对窦性心律的缺血性中风患者进行心率监测和管理以潜在减轻肾功能下降的重要性。需要进一步研究以探讨房颤患者及不同种族人群中的这种关系。
