title: A low baseline glomerular filtration rate predicts poor clinical outcome at 3 months after acute ischemic stroke.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study.
  
  
  METHODS
  This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2). The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score ≥3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of ≥4 at discharge compared to baseline) during hospitalization and in-hospital mortality.
  
  
  RESULTS
  The overall eGFR was 84.5±20.8 mL/min/1.73 m(2) (mean±SD). The distribution of baseline renal impairment was as follows: 1,218, 82, 40, and 33 patients had eGFRs of ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively. At 3 months after the stroke, 476 (34.7%) patients exhibited poor functional outcome. Furthermore, a poor functional outcome occurred more frequently with increasingly advanced stages of CKD (rates of 31.9%, 53.7%, 55.0%, and 63.6% for CKD stages 1/2, 3a, 3b, and 4/5, respectively; p<0.001). Multivariate analysis revealed that a baseline eGFR of <30 mL/min/1.73m(2) increased the risk of a poor functional outcome by 2.37-fold (p=0.047). In addition, baseline renal dysfunction was closely associated with neurological deterioration during hospitalization and with in-hospital mortality.
  
  
  CONCLUSIONS
  A low baseline eGFR was strongly predictive of both poor functional outcome at 3 months after ischemic stroke and neurological deterioration/mortality during hospitalization.
authors: Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: Hyung Jik
authors: HJ
authors: Kim
authors: Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: Jwa-Kyung
authors: JK
authors: Kim
authors: Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: Mi Sun
authors: MS
authors: Oh
authors: Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: Sung Gyun
authors: SG
authors: Kim
authors: Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: Kyung-Ho
authors: KH
authors: Yu
authors: Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: Byung-Chul
authors: BC
authors: Lee
keywords: chronic kidney disease; functional outcome; mortality; stroke
references: Stroke. 2002 Jun;33(6):1630-5
references: 12053003
references: JAMA. 2001 Jul 25;286(4):421-6
references: 11466120
references: Circulation. 2003 Oct 28;108(17):2154-69
references: 14581387
references: Nephrol Dial Transplant. 2009 Jan;24(1):194-200
references: 18728156
references: Cerebrovasc Dis. 2009;28(6):582-8
references: 19844098
references: Eur Neurol. 2010;63(4):237-42
references: 20332640
references: Diabetes Care. 2014;37(1):173-9
references: 24009297
references: Eur J Neurol. 2014 Aug;21(8):1143-5
references: 24261457
references: Lancet. 2010 Jun 12;375(9731):2073-81
references: 20483451
references: Am J Cardiol. 1997 Jul 15;80(2):164-9
references: 9230153
references: Neurology. 2012 Jun 12;78(24):1909-15
references: 22592359
references: Cerebrovasc Dis. 2011;31(2):123-9
references: 21088392
references: Circulation. 2003 Dec 2;108(22):2769-75
references: 14638545
references: N Engl J Med. 2004 Sep 23;351(13):1285-95
references: 15385655
references: Kidney Int. 2011 Jul;80(1):17-28
references: 21150873
references: Stroke. 2014 Feb;45(2):587-90
references: 24302481
references: Nephrol Dial Transplant. 2010 Apr;25(4):1150-7
references: 19945951
references: Diabet Med. 1995 Feb;12(2):149-55
references: 7743762
references: PLoS One. 2013 Nov 22;8(11):e80527
references: 24278288
references: Stroke. 2009 Apr;40(4):1296-303
references: 19182072