title: Proteinuria and clinical outcomes after ischemic stroke.
abstract: OBJECTIVE
  The impact of chronic kidney disease (CKD) on clinical outcomes after acute ischemic stroke is still not fully understood. The aim of the present study was to elucidate how CKD and its components, proteinuria and low estimated glomerular filtration rate (eGFR), affect the clinical outcomes after ischemic stroke.
  
  
  METHODS
  The study subjects consisted of 3,778 patients with first-ever ischemic stroke within 24 hours of onset from the Fukuoka Stroke Registry. CKD was defined as proteinuria or low eGFR (<60 mL/min/m(2)) or both. The study outcomes were neurologic deterioration (≥2-point increase in the NIH Stroke Scale during hospitalization), in-hospital mortality, and poor functional outcome (modified Rankin Scale score at discharge of 2 to 6). The effects of CKD, proteinuria, and eGFR on these outcomes were evaluated using a multiple logistic regression analysis.
  
  
  RESULTS
  CKD was diagnosed in 1,320 patients (34.9%). In the multivariate analyses after adjusting for confounding factors, patients with CKD had significantly higher risks of neurologic deterioration, in-hospital mortality, and poor functional outcome (p <0.001 for all). Among the CKD components, a higher urinary protein level was associated with an elevated risk of each outcome (p for trend < 0.001 for all), but no clear relationship between the eGFR level and each outcome was found.
  
  
  CONCLUSIONS
  CKD is an important predictor of poor clinical outcomes after acute ischemic stroke. Proteinuria independently contributes to the increased risks of neurologic deterioration, mortality, and poor functional outcome, but the eGFR may not be relevant to these outcomes.
authors.affiliation: Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka Higashi Medical Center, Fukuoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kumai
authors.forename: M
authors.initials: M
authors.lastname: Kamouchi
authors.forename: J
authors.initials: J
authors.lastname: Hata
authors.forename: T
authors.initials: T
authors.lastname: Ago
authors.forename: J
authors.initials: J
authors.lastname: Kitayama
authors.forename: H
authors.initials: H
authors.lastname: Nakane
authors.forename: H
authors.initials: H
authors.lastname: Sugimori
authors.forename: T
authors.initials: T
authors.lastname: Kitazono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D011507:Proteinuria / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000503:physiopathology