Abstract

Background and aims: This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. Methods: From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic stroke patients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis. The risks of 1-month, 3-month and 1-year recurrent stroke related to the eGFR levels were investigated. Results: Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis, respectively. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted subhazard ratio of 1-month recurrent stroke decreased from 1.69 (95% confidence interval (CI) = 1.24–2.31) for patients with eGFR < 30 mL/min/1.73 m2 or on dialysis to 1.14 (95% CI = 0.91–1.43) for patients with eGFRs of 60–89 mL/min/1.73 m2, considering the competing risk of deaths. Similar patterns were also observed for the adjusted HRs of 3-month and 1-year recurrent stroke, but with reduced hazard values, by the corresponding eGFR levels. Conclusions: There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.

Original languageEnglish
Pages (from-to)15-20
Number of pages6
JournalAtherosclerosis
Volume277
DOIs
Publication statusPublished - Oct 1 2018

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Stroke
Kidney
Dialysis
Confidence Intervals
Glomerular Filtration Rate
Taiwan
Registries
Incidence

Keywords

  • Estimated glomerular filtration rate
  • Ischemic stroke
  • Recurrent stroke
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke. / Taiwan Stroke Registry Investigators.

In: Atherosclerosis, Vol. 277, 01.10.2018, p. 15-20.

Research output: Contribution to journalArticle

Taiwan Stroke Registry Investigators. / Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke. In: Atherosclerosis. 2018 ; Vol. 277. pp. 15-20.
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title = "Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke",
abstract = "Background and aims: This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. Methods: From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic stroke patients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis. The risks of 1-month, 3-month and 1-year recurrent stroke related to the eGFR levels were investigated. Results: Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis, respectively. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted subhazard ratio of 1-month recurrent stroke decreased from 1.69 (95{\%} confidence interval (CI) = 1.24–2.31) for patients with eGFR < 30 mL/min/1.73 m2 or on dialysis to 1.14 (95{\%} CI = 0.91–1.43) for patients with eGFRs of 60–89 mL/min/1.73 m2, considering the competing risk of deaths. Similar patterns were also observed for the adjusted HRs of 3-month and 1-year recurrent stroke, but with reduced hazard values, by the corresponding eGFR levels. Conclusions: There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.",
keywords = "Estimated glomerular filtration rate, Ischemic stroke, Recurrent stroke, Renal function",
author = "{Taiwan Stroke Registry Investigators} and Wang, {I. Kuan} and Lien, {Li Ming} and Lee, {Jiunn Tay} and Liu, {Chung Hsiang} and Chen, {Chih Hung} and Lin, {Ching Huang} and Jeng, {Jiann Shing} and Hu, {Chaur Jong} and Yen, {Tzung Hai} and Chen, {Sien Tsong} and Chiu, {Hou Chang} and Tsai, {I. Ju} and Sung, {Fung Chang} and Hsu, {Chung Y.}",
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T1 - Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke

AU - Taiwan Stroke Registry Investigators

AU - Wang, I. Kuan

AU - Lien, Li Ming

AU - Lee, Jiunn Tay

AU - Liu, Chung Hsiang

AU - Chen, Chih Hung

AU - Lin, Ching Huang

AU - Jeng, Jiann Shing

AU - Hu, Chaur Jong

AU - Yen, Tzung Hai

AU - Chen, Sien Tsong

AU - Chiu, Hou Chang

AU - Tsai, I. Ju

AU - Sung, Fung Chang

AU - Hsu, Chung Y.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background and aims: This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. Methods: From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic stroke patients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis. The risks of 1-month, 3-month and 1-year recurrent stroke related to the eGFR levels were investigated. Results: Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis, respectively. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted subhazard ratio of 1-month recurrent stroke decreased from 1.69 (95% confidence interval (CI) = 1.24–2.31) for patients with eGFR < 30 mL/min/1.73 m2 or on dialysis to 1.14 (95% CI = 0.91–1.43) for patients with eGFRs of 60–89 mL/min/1.73 m2, considering the competing risk of deaths. Similar patterns were also observed for the adjusted HRs of 3-month and 1-year recurrent stroke, but with reduced hazard values, by the corresponding eGFR levels. Conclusions: There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.

AB - Background and aims: This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. Methods: From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic stroke patients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis. The risks of 1-month, 3-month and 1-year recurrent stroke related to the eGFR levels were investigated. Results: Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60–89, 30–59, and <30 mL/min/1.73 m2 or on dialysis, respectively. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted subhazard ratio of 1-month recurrent stroke decreased from 1.69 (95% confidence interval (CI) = 1.24–2.31) for patients with eGFR < 30 mL/min/1.73 m2 or on dialysis to 1.14 (95% CI = 0.91–1.43) for patients with eGFRs of 60–89 mL/min/1.73 m2, considering the competing risk of deaths. Similar patterns were also observed for the adjusted HRs of 3-month and 1-year recurrent stroke, but with reduced hazard values, by the corresponding eGFR levels. Conclusions: There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.

KW - Estimated glomerular filtration rate

KW - Ischemic stroke

KW - Recurrent stroke

KW - Renal function

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