Indices of kidney dysfunction and discharge outcomes in hospitalized stroke patients without known renal disease.
BACKGROUND
The utility of clinical measurements of impairments in glomerular barrier or filtration rate among hospitalized stroke patients without known chronic kidney disease (CKD) has not been well studied. We determined whether various indices of CKD would predict discharge outcomes in persons hospitalized with a recent ischemic stroke.


METHODS
Presence of proteinuria and estimated low glomerular filtration rate (GFR) <60 ml/min per 1.73 m(2) on admission were assessed in consecutive ischemic stroke and transient ischemic attack patients admitted to a university hospital over 18 months, who had no history of CKD. The primary discharge outcomes assessed (among stroke patients only) were death or disability (modified Rankin Scale score > or =2) and being discharged home directly from hospital. Independent effects of CKD indices on the outcomes were evaluated using multivariable regression modeling.


RESULTS
Of 251 patients with recent ischemic cerebrovascular events, 198 ischemic stroke patients (79%), met the study criteria. In crude analyses, persons with proteinuria or low GFR were significantly more likely to die in the hospital (p < 0.05). After adjusting for confounders, proteinuria was independently linked with lower odds of going home directly from the hospital (OR = 0.38, 95% CI = 0.16-0.92) and poorer discharge functional status (OR = 3.19, 95% CI = 1.37-7.46), but low GFR was not independently related to either of these outcomes.


CONCLUSIONS
Among hospitalized ischemic stroke patients without known CKD, presence of proteinuria on admission is independently associated with poorer discharge functional activity and lower likelihood of being discharged home directly. Low GFR was not related to either outcome in these patients without known CKD.
Stroke Center and Department of Neurology, UCLA Medical Center, University of Southern California, 710 Westwood Plaza, Los Angeles, CA 90095, USA. ovibes @ mednet.ucla.edu
Bruce
B
Ovbiagele
Nerses
N
Sanossian
David S
DS
Liebeskind
Doojin
D
Kim
Latisha K
LK
Ali
Sandra
S
Pineda
Jeffrey L
JL
Saver
D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology* / Q000503:physiopathology / Q000652:urine; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis* / Q000652:urine