Role of chronic kidney disease and atrial fibrillation in outcomes of patients with ischemic stroke

The aim was to analyze spectrum of comorbid pathology and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease. Materials and methods. The study included 85 oxygen-dependent patients with severe COVID-19. The patients were divided into groups: I – 70 patients with recovery; II – 15 patients in whom the disease was fatal. Statistical data processing was performed in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Among the patients with fatal outcomes of the disease, elderly and senile were dominated – 93.3 % (14 of 15) versus 67.1 % (47 of 70) among patients who recovered (P < 0.05). Analysis of comorbid pathology structure in oxygen-dependent patients with severe COVID-19 showed that patients who died more often had hypertension (93.3 % vs. 30.0 %, P < 0.001), postinfarction cardiosclerosis (26.7 % vs. 2.9 %, P < 0.001), rhythm disturbance as persistent atrial fibrillation (20.0 % vs. 1.4 %, P < 0.01) as compared to those who survived. The patients of group II were more commonly diagnosed with chronic kidney disease (20.0 % vs. 4.3 %, P < 0.05) as the comorbid pathology. The presence of ischemic stroke in COVID-19 infection influenced the disease outcome (20.0 % vs. 4.3 %, P < 0.05). Fatal outcomes in the patients with COVID-19 were associated with a combination of 3 or more comorbid conditions in 46.7 % versus 17.4 % among oxygen-dependent survivors with severe disease (P < 0.01). Conclusions. Elderly and senile oxygen-dependent patients are more likely to die from severe COVID-19 (P < 0.05). Comorbid hypertension, postinfarction cardiosclerosis, arrhythmia in the form of persistent atrial fibrillation, chronic kidney disease and ischemic stroke or the combination of 3 or more comorbid conditions listed are more common among patients with COVID-19 who died (P < 0.05) as compared to survivors.

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Cerebral Microbleeds and Chronic Kidney Disease in Acute Ischemic Stroke Patients with Atrial Fibrillation

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104650 ◽

2020 ◽

Vol 29 (4) ◽

pp. 104650

Author(s):

Kazuo Yamashiro ◽

Ryota Tanaka ◽

Naohide Kurita ◽

Yuji Ueno ◽

Nobukazu Miyamoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Ischemic Stroke ◽

Kidney Disease ◽

Acute Ischemic Stroke ◽

Cerebral Microbleeds ◽

Stroke Patients

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Prediction of unfavorable outcome in ischemic stroke patients with chronic kidney disease

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.4(72).2021.07 ◽

2021 ◽

pp. 53-59

Author(s):

A. Antonenko ◽

K. Antonenko ◽

L. Vakulenko ◽

Z. Dubovenko

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Ischemic Stroke ◽

Prognostic Factors ◽

Kidney Disease ◽

Functional Outcomes ◽

Unfavorable Outcome ◽

Stroke Outcome ◽

Basic Characteristics

Patients with chronic kidney disease (CKD) have significantly poorer functional outcomes and greater mortality after suffering a stroke. The present study aimed to identify the prognostic factors of an unfavorable outcome of the ischemic stroke in patients with CKD. Methods and subjects. The current study was designed retrospectively and performed with data of patients who were hospitalized due to ischemic stroke to the neurological department. A complex clinical and neuroimaging investigation was carried out in 65 patients (30 men and 35 women) aged 53 to 81 years (mean age – (67.7 ± 5.9) years) with acute stroke and CKD. Patients underwent all the necessary ancillary investigations according to guidelines. According to the clinical outcome on the 21-st day by the modified Rankin scale (mRS) all patients were divided into two groups: 1-st –favorable stroke outcome (mRS=0-3) – 34 (52.3%), 2-nd – unfavorable stroke outcome – (mRS=4-6) – 31 (47.7%). Results. During comparing the basic characteristics of both groups, it was revealed that patients with unfavorable functional outcomes were almost twice as likely to have diabetes mellitus (51.6% vs. 26.5%, p<0.037) and atrial fibrillation (41.9% vs. 17.6%, p<0.032). In age-and sex-adjusted multifactor logistic regression it was found that ischemic stroke unfavorable outcome is associated with diabetes mellitus (OR – 2.5, CI: 1.6-8.3; p=0.014), atrial fibrillation – 2.7, CI: 0.7-9.6; p=0.043), dialysis therapy (OR – 3.4, CI: 2.3-8.1; p=0.007), GFR <42 ml/min/1.73 m2 (OR – 2.7, CI: 2.1-7.8; p=0.003). Conclusions. Determining prognostic factors of unfavorable course of the ischemic stroke in patients with CKD allows to optimize the management of such patients in the acute period of ischemic stroke and improve the prognosis.

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Associations of atrial fibrillation with renal function decline in patients with chronic kidney disease

Heart ◽

10.1136/heartjnl-2021-319297 ◽

2021 ◽

pp. heartjnl-2021-319297

Author(s):

Tz-Heng Chen ◽

Yuan-Chia Chu ◽

Shuo-Ming Ou ◽

Der-Cherng Tarng

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Propensity Scores ◽

Renal Function Decline ◽

Stage Renal Disease ◽

End Stage ◽

Egfr Decline

BackgroundChronic kidney disease (CKD) is known to increase the risk of atrial fibrillation (AF) development, but the relationship between AF and subsequent renal function decline in patients with CKD is not well understood. In this study, we explored the role of AF on renal outcomes among patients with CKD.MethodsIn a retrospective hospital-based cohort study, we identified patients with CKD aged ≥20 years from 1 January 2008 to 31 December 2018. The patients were divided into AF and non-AF groups. We matched each patient with CKD and AF to two non-AF CKD controls according to propensity scores. The outcomes of interest included estimated glomerular filtration rate (eGFR) decline of ≥20%, ≥30%, ≥40% and ≥50%, and end-stage renal disease (ESRD).ResultsAfter propensity score matching, 6731 patients with AF and 13 462 matched controls were included in the analyses. Compared with the non-AF group, the AF group exhibited greater risks of eGFR decline ≥20% (HR 1.43; 95% CI 1.33 to 1.53), ≥30% (HR 1.50; 95% CI 1.36 to 1.66), ≥40% (HR 1.62; 95% CI 1.41 to 1.85) and ≥50% (HR 1.82; 95% CI 1.50 to 2.20), and ESRD (HR 1.22; 95% CI 1.12 to 1.34). Higher CHA2DS2-VASc scores were associated with greater risks of eGFR decline and ESRD.ConclusionsIn patients with CKD, AF was associated with greater risks of subsequent renal function decline. CHA2DS2-VASc scores may be a useful risk stratification scheme for predicting the risk of renal function decline.

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Establishment of a model of atrial fibrillation associated with chronic kidney disease in rats and the role of oxidative stress

Heart Rhythm ◽

10.1016/j.hrthm.2012.08.019 ◽

2012 ◽

Vol 9 (12) ◽

pp. 2023-2031 ◽

Cited By ~ 31

Author(s):

Naoya Fukunaga ◽

Naohiko Takahashi ◽

Satoshi Hagiwara ◽

Osamu Kume ◽

Akira Fukui ◽

...

Keyword(s):

Oxidative Stress ◽

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease

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The predictor role of worsening renal function in patients with new onset atrial fibrillation on direct oral anticoagulant

European Heart Journal ◽

10.1093/ehjci/ehaa946.0652 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Bartoli ◽

F Angeli ◽

A Stefanizzi ◽

P Paolisso ◽

L Bergamaschi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Cardiovascular Events ◽

Independent Predictor ◽

Newly Diagnosed ◽

Prognostic Role ◽

Worsening Renal Function

Abstract Background Chronic kidney disease (CKD) is an important outcome predictor in patients with atrial fibrillation (AF). Moreover, renal function at baseline is used to guide oral anticoagulant (OA) selection and dosing at initial treatment. The prognostic role of worsening renal function (WRF) during treatment with direct oral anticoagulants (DOACS) has been poorly explored. Purpose To estimate the prognostic role of WRF in terms of major adverse cardiovascular events (MACEs) in a series of patients with newly diagnosed non-valvular AF (NVAF) treated with DOACs. Methods Among all patients with newly diagnosed NVAF and indication for OA between January 2017 and December 2018, we enrolled those treated with DOACs. Renal function at baseline and during follow-up was assessed with estimated glomerular filtration rates (eGFR). eGFR was calculated as a mean value of Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. The hemorrhagic risk at baseline was estimated with the main available scores (HAS-BLED, ATRIA and ORBIT). WRF was defined as a decrease in eGFR of at least 20%. MACEs were evaluated according to the type of DOAC and the WRF. Major bleedings (MB) were defined according to the ISTH definition. Results The study population was constituted by 249 patients with newly diagnosed NVAF started on DOAC and followed for a median time of 14.1±8.6 months. Overall, WRF was observed in 58 cases (23.3%). Patients with WRF had significative higher rates of death (10.3% versus 3.1%, p=0.025) and MB (13.8% versus 4.7%, p=0.016). The incidence of bleeding events, acute coronary syndromes and stroke was not affected by WRF. Interestingly, CG formula better predicted the incidence of MB as compared to the other formulas (p=0.006). The type of DOAC did not significantly impact the observed renal impairment and had no effect on the occurrence of MACEs in patients showing WRF. The predictors of WRF were found to be age, female sex, low hemoglobin level and left ventricle end telediastolic volume. At multivariate analysis, WRF was identified as an independent predictor of MB (OR 3.1, 95% C.I, 1.12–8.58), regardless of the baseline bleeding risk. Conclusion This is the first prospective study to evaluate the impact of worsening renal function on cardiovascular events in patients with atrial fibrillation treated with DOACs. A significant WRF emerged as an independent predictor of death and MB. The specific DOAC did not affect either the entity of worsening renal function or the incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

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The association of anticoagulation, ischemic stroke, and hemorrhage in elderly adults with chronic kidney disease and atrial fibrillation

Kidney International ◽

10.1016/j.kint.2016.10.017 ◽

2017 ◽

Vol 91 (4) ◽

pp. 928-936 ◽

Cited By ~ 24

Author(s):

Vaibhav Keskar ◽

Eric McArthur ◽

Ron Wald ◽

Ziv Harel ◽

Deborah Zimmerman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Ischemic Stroke ◽

Kidney Disease ◽

Elderly Adults

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Potential effect of pharmaceutical care to improve outcomes in patients with chronic kidney disease-mineral bone disorder in Sulaimani dialysis centers

Al Mustansiriyah Journal of Pharmaceutical Sciences ◽

10.32947/ajps.20.01.0442 ◽

2020 ◽

pp. 82-94

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Pharmaceutical Care ◽

Biochemical Parameters ◽

Positive Impact ◽

Potential Effect ◽

Care Group ◽

Mineral Bone Disorder ◽

Bone Disorder

Objective: the present study was aimed to evaluate the role of pharmaceutical services in improving the outcome of mineral bone disorder in patients with advanced chronic kidney disease. Methodology: One hundred and twenty patients with chronic kidney disease-mineral bone disorder (CKD-MBD) screened for eligibility, seventy-six patients enrolled in the study and randomly allocated into two groups: pharmaceutical care and usual care, both groups interviewed by the pharmacist using specific questionnaire for assessing the quality of life (QoL). All the drug related problems (DRPs) including drug-drug interactions (DDIs) were recorded by the pharmacist. Blood samples were collected and utilized for analyzing the levels of vitamin D, phosphorous, calcium, albumin and parathyroid hormone at baseline and three months after. The pharmaceutical care group received all the educations about their medications and how to minimize DRPs; improve the QoL. Additionally, the pharmaceutical intervention included correcting the biochemical parameters. Results: Pharmaceutical care significantly improved patients QoL and minimized DRPs and DDIs. It was also effective in improving the biochemical parameters. Conclusion: Pharmaceutical care has a positive impact on improving the outcome of patients with CKD-MBD through attenuating DRPs, improving the biochemical parameters and the QoL.

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