Kidney Dysfunction and Damage independently associated with increased risks of recurrent stroke and Death

Japan: A new study published in Stroke: AHA journal has found that chronic kidney disease and its underlying pathological conditions, kidney dysfunction, and kidney damage, are independently associated with increased risks of recurrent stroke and all-cause death in patients with ischemic stroke.

Chronic kidney disease is a significant public health issue, affecting millions of people worldwide and increasing the risk of cardiovascular disease and death. The purpose of this study was to see if renal dysfunction (lower estimated glomerular filtration rate), kidney injury (proteinuria), or both were linked to long-term outcomes following an ischemic stroke.

The study, conducted by researchers at the Fukuoka Stroke Registry, followed 12,576 patients with ischemic stroke and assessed their kidney function by estimating glomerular filtration rate and proteinuria using a urine dipstick test.

Kidney function was categorized into three groups:

• G1 (≥60 mL/ (min·1.73 m2))
• G2 (45–59 mL/ (min·1.73 m2))
• G3 (<45 mL/ (min·1.73 m2))

While proteinuria was classified into three categories:

• P1 (-)
• P2 (±/1+)
• P3 (≥2+)

During the median follow-up of 4.3 years, the study concluded with the following clinical findings:

1. 1.The study found that 2481 patients had recurrent strokes and 4032 patients died.
2. 2.Chronic kidney disease was independently associated with increased risks of stroke recurrence and all-cause death even after adjusting for multiple confounding factors, including traditional cardiovascular risk factors.
3. 3.Both estimated glomerular filtration rate and proteinuria were independently associated with increased risks of stroke recurrence and death.
4. 4.Subgroup analysis revealed effect changes in the link of proteinuria with death based on age and stroke subtype.

The study's findings highlight the importance of identifying and managing kidney dysfunction and damage in patients with ischemic stroke to reduce the risks of recurrent stroke and all-cause death.

Dr. Kana Ueki, lead author of the study added that “Proteinuria was associated with an increased risk of death in older patients and those with certain stroke subtypes, suggesting the need for targeted interventions in these patient groups. Further studies are needed to investigate the underlying mechanisms linking kidney dysfunction and damage with stroke recurrence and death, as well as to evaluate the effectiveness of interventions.”

Reference:

Ueki K., Matsuo R., Kuwashiro T., Irie F., Wakisaka Y., Ago T., Kamouchi M., Kitazono T.; Decreased Estimated Glomerular Filtration Rate and Proteinuria and Long-Term Outcomes After Ischemic Stroke: A Longitudinal Observational Cohort Study, STROKE: AHA 2023.04.06 doi: https://doi.org/10.1161/STROKEAHA.122.040958