title: Prevalence and Significance of Unrecognized Renal Dysfunction in Patients with Stroke.
abstract: Unrecognized renal dysfunction, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) in the presence of normal serum creatinine levels, is a common comorbidity among patients with various cardiovascular conditions. The current study was aimed to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients with acute stroke.
  
  
  
  The cohort consisted of patients with acute stroke included in the prospective National Acute Stroke ISraeli (NASIS) registry. Unrecognized renal insufficiency was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) in the presence of serum creatinine ≤1.2 mg/dL. The 2 primary outcomes were in-hospital mortality and the composite of in-hospital mortality or severe disability at hospital discharge.
  
  
  
  Of the 7900 patients with stroke included in the study, 5571 (70.5%) had normal renal function, 1510 (19.1%) had recognized renal insufficiency, and 819 (10.4%) had unrecognized renal insufficiency. Mortality rates were higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (9.9%, 9.1%, and 4.4%, respectively, P < .0001). Adjusted odds ratios (ORs) for in-hospital mortality were higher for patients with renal dysfunction recognized (OR, 2.1; 95% confidence interval [CI], 1.6-2.7; P < .001) or unrecognized (OR, 1.6; 95% CI, 1.1-2.2; P = .006) compared with patients with normal renal function. Likewise, adjusted ORs for the composite of in-hospital mortality or severe disability at hospital discharge were higher for patients with renal dysfunction recognized (OR, 1.3; 95% CI, 1.1-1.5; P = .004) or unrecognized (OR, 1.2; 95% CI, 1.01-1.5; P = .04).
  
  
  
  Unrecognized renal insufficiency is common among patients with acute stroke and is associated with adverse short-term outcomes.
authors.affiliation: Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; Department of Neurology, Carmel Medical Center, Haifa, Israel. Electronic address: davidpe@post.tau.ac.il.
authors.forename: David
authors.initials: D
authors.lastname: Pereg
authors.affiliation: Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Israel.
authors.forename: Zach
authors.initials: Z
authors.lastname: Rozenbaum
authors.affiliation: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: Dina
authors.initials: D
authors.lastname: Vorobeichik
authors.affiliation: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: Department of Neurology, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Gilad
authors.affiliation: Department of Neurology, Carmel Medical Center, Haifa, Israel.
authors.forename: Sivan
authors.initials: S
authors.lastname: Bloch
authors.affiliation: Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Morris
authors.initials: M
authors.lastname: Mosseri
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012042:Registries; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality
chemical_list: D003404:Creatinine
keywords: Glomerular filtration rate; Mortality; Renal dysfunction; Stroke