scholarly journals Influence of Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients with Acute Ischemic Stroke Not Receiving Reperfusion Therapies

2021 ◽  
Vol 10 (20) ◽  
pp. 4719
Author(s):  
Mi-Yeon Eun ◽  
Jin-Woo Park ◽  
Bang-Hoon Cho ◽  
Kyung-Hee Cho ◽  
Sungwook Yu
Keyword(s):  
Ischemic Stroke ◽  
Glomerular Filtration Rate ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation

Background: We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy. Methods: A total of 1420 patients with acute ischemic stroke from a hospital-based stroke registry were included in this study. Patients managed with intravenous thrombolysis or endovascular reperfusion therapy were excluded. The included patients were categorized into five groups according to eGFR, as follows: ≥90, 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2. The effects of eGFR on functional outcome at discharge, in-hospital mortality, neurologic deterioration, and hemorrhagic transformation were evaluated using logistic regression analyses. Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge (p < 0.001) and in-hospital mortality (p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. However, no significant associations were observed between eGFR and any clinical outcomes in multivariable analysis after adjusting for clinical and laboratory variables. Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy.

scholarly journals Estimated glomerular filtration rate may be an independent predictor for clinical outcomes regardless of acute kidney injury complication in the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258665
Author(s):  
Ryohei Horie ◽  
Yuri Endo ◽  
Kent Doi
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Renal Dysfunction ◽  
Clinical Outcomes ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Composite Outcome

Study objective Acute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting. Methods Adult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category. Results Among 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45–2.05], 1.36 [1.16–1.59], 1.66 [1.39–2.00], 1.73 [1.32–2.28], and 2.71 [1.73–4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD. Conclusions Estimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.

Low Glomerular Filtration Rate Increases Hemorrhagic Transformation in Acute Ischemic Stroke

2013 ◽  
Vol 35 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Jung-Gon Lee ◽  
Kyung Bok Lee ◽  
Il-Mi Jang ◽  
Hakjae Roh ◽  
Moo-Young Ahn ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glomerular Filtration Rate ◽  
Acute Ischemic Stroke ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Hemorrhagic Transformation

Abstract 19892: Association Between Estimated-glomerular Filtration Rate and Clinical Outcomes at One Year After Acute Ischemic Stroke

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
xiaoqing bu ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Hao Peng ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
The Relationship

Introduction: The relationship between estimated-glomerular filtration rate (eGFR) and acute ischemic stroke outcomes remains controversial. Hypothesis: We aimed to evaluate the impact of eGFR on all-cause mortality, recurrent stroke, and vascular events in patients with acute ischemic stroke. Methods: 4036 patients with acute ischemic stroke recruited from 26 hospitals across China from August 2009 to May 2013 were included in our study. GFR was estimated by CKD-EPI equations based on serum creatinine and/or cystatin C (CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys). The Cox proportional hazards models were used to examine the relationship between declined eGFR and 1-year all-cause mortality, recurrent stroke, and vascular events. Declined eGFR was defined as <60 mL/min /1.73 m2. Results: Declined eGFR was present in 7.22% (n=281) of patients based on the CKD-EPIcr equation, 3.43% (n=119) based on the CKD-EPIcys equation, and 5.67% (n=170) based on the CKD-EPIcr-cys equation. Compared to patients with an eGFR ≥90 mL/min /1.73 m2, adjusted hazard ratios (95% confidence interval) for all-cause mortality associated with eGFR<60 mL/min /1.73 m2 were 1.68 (1.06 to 2.66, p=0.026), 2.29 (1.29 to 4.06, p=0.005), and 1.79 (1.08 to 2.98, p=0.024) using CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, respectively. For recurrent stroke, adjusted hazard ratios (95% confidence interval) were 0.90 (0.49 to 1.66, p=0.743), 0.60 (0.19 to 1.93, p=0.393), and 0.89 (0.40 to 1.95, p=0.762), respectively. For vascular events, adjusted hazard ratios (95% confidence interval) were 1.33 (0.81 to 2.19, p=0.266), 1.07 (0.46 to 2.47, p=0.880), and 1.31 (0.70 to 2.43, p=0.403), respectively. Conclusion: Our study indicates that declined eGFR is a strong independent risk factor for total mortality among patients with acute ischemic stroke. However, there is no association between low eGFR and recurrent stroke or vascular events among patients with acute ischemic stroke. In addition, the association of eGFR with all-cause mortality among patients with acute ischemic stroke is stronger when eGFR was calculated based on the CKD-EPIcys equation compared to CKD-EPIcr and CKD-EPIcr-cys equations.

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