Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study.
OBJECTIVE
The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke.


METHODS
This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between 1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality.


RESULTS
The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine <124 micromol/L. The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance > or =51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine > or =119 micromol/L "relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92", urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or > or =9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine > or =0.08573 mmol/micromol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders.


CONCLUSIONS
After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.
MacWalter
Ronald S
RS
Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland. ronald.macwalter@tuht.scot.nhs.uk
Wong
Suzanne Y S
SY
Wong
Kenneth Y K
KY
Stewart
Graham
G
Fraser
Callum G
CG
Fraser
Hazel W
HW
Ersoy
Yuksel
Y
Ogston
Simon A
SA
Chen
Rouling
R
D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis; D014508:Urea / Q000097:blood
D014508:Urea; D003404:Creatinine