Proteinuria and clinical outcomes after ischemic stroke
Abstract
Objectives:
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/m2) 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.
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Copyright © 2012 by AAN Enterprises, Inc.
Publication History
Received: June 25, 2011
Accepted: October 17, 2011
Published online: May 16, 2012
Published in print: June 12, 2012
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Authors
Author Contributions
Y. Kumai contributed to drafting the manuscript for content, study concept, analysis of data, and acquisition of data. M. Kamouchi contributed to drafting the manuscript for content, study concept, analysis of data, acquisition of data, and statistical analysis. J. Hata contributed to the study concept and statistical analysis. T. Ago contributed to the study concept, analysis of data, and acquisition of data. J. Kitayama contributed to the analysis of data and acquisition of data. H. Nakane contributed to the study concept, acquisition of data, and study supervision. H. Sugimori contributed to the study concept, analysis of data, and study supervision. T. Kitazono contributed to the study concept, study supervision, and obtaining funding.
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