title: Impaired renal function in stroke patients with atrial fibrillation.
abstract: BACKGROUND
  Stroke patients with atrial fibrillation (AF) are prone to have comorbidities such as impaired renal function. Because poly-pharmacotherapy is often required in those patients, renal function is important to consider in light of renally cleared medications such as direct oral anticoagulants. In this study, we analyzed frequency and predictors for impaired renal function and its impact on functional outcome in stroke patients with underlying AF.
  
  
  METHODS
  We analyzed 272 patients with acute ischemic stroke and AF of our prospective, observational stroke database. Estimated glomerular filtration rate (eGFR) was calculated on admission and during hospitalization from the equation of the Modification Diet for Renal Disease. Outcome measures included mortality and functional outcome at 90 days, assessed as modified Rankin Scale (mRS) score.
  
  
  RESULTS
  On admission, impaired renal function was found in 41.5% (n = 113) and was associated with worse 90-day outcome (mRS score ≤ 2: 26.5% versus 45.9%, P = .001) and a higher mortality rate (23.9% versus 14.5%, P = .043). Multivariate logistic regression identified older age and history of myocardial infarction as independent predictors of renal dysfunction on admission (P < .05). Normalization of eGFR during hospitalization was achieved in 55.8%.
  
  
  CONCLUSIONS
  In patients with acute ischemic stroke and AF, impaired renal function on admission is frequent and associated with worse outcome. Normalization of eGFR can often be achieved during hospitalization, but in everyday life, fluctuations of renal function because of infection or dehydration have to be considered. Careful monitoring of renal status is indispensable and should influence drug treatment decisions.
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany. Electronic address: Eva-Maria.Sauer@uk-erlangen.de.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Sauer
authors.affiliation: Department of Neuroradiology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Sauer
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Kallmünzer
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Blinzler
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Breuer
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
keywords: Acute ischemic stroke; atrial fibrillation; direct oral anticoagulants; kidney disease; oral anticoagulation; renal dysfunction