title: Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease.
abstract: BACKGROUND
  Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in-hospital prognoses among patients with CKD in the Get With The Guidelines-Stroke (GWTG-Stroke) program
  
  
  RESULTS
  We analyzed 679 827 patients hospitalized with ischemic stroke from 1564 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. Use of 7 predefined ischemic stroke performance measures, composite "defect-free" care compliance, and in-hospital mortality were examined based on glomerular filtration rate (GFR) categorized as a dichotomous (+CKD as <60) or rank-ordered variable: normal (≥ 90), mild (≥ 60 to <90), moderate (≥ 30 to <60), severe (≥ 15 to <30), and kidney failure (<15 or dialysis). There were 236 662 (35%) ischemic stroke patients with CKD. Patients with severe renal dysfunction or failure were significantly less likely to receive guideline-based therapies. Compared with patients with normal kidney function (≥ 90), those with CKD (adjusted OR 0.91 [95% CI: 0.89 to 0.92]), moderate dysfunction (adjusted OR 0.94 [95% CI: 0.92 to 0.97]), severe dysfunction (adjusted OR 0.80 [95% CI: 0.77 to 0.84]), or failure (adjusted OR 0.72 [95% CI: 0.68 to 0.0.76]), were less likely to receive 100% defect-free care measure compliance. Inpatient mortality was higher for patients with CKD (adjusted odds ratio 1.44 [95% CI: 1.40 to 1.47]), and progressively rose with more severe renal dysfunction.
  
  
  CONCLUSIONS
  Despite higher in-hospital mortality rates, ischemic stroke patients with CKD, especially those with greater severity of renal dysfunction, were less likely to receive important guideline-recommended therapies.
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, SC (B.O.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Division of Neurology, Massachusetts General Hospital, Boston, MA (L.H.S.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (E.E.S.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.S., A.F.H., E.D.P.).
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.affiliation: Stroke Center and Department of Neurology, University of California, Los Angeles, CA (J.L.S.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.S., A.F.H., E.D.P.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.S., A.F.H., E.D.P.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Division of Cardiolog, University of California, Los Angeles, CA (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: chronic kidney disease; glomerular Filtration Rate; guidelines; ischemic stroke; outcomes; prognosis; quality indicators; renal