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Factors Associated With Impaired Kidney Function and Its Impact on Long-Term Outcome in Young Ischemic Stroke.
MedLine Citation:
PMID:  21737795     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: After ischemic stroke, kidney dysfunction is linked to poor outcomes in the elderly, but regarding young patients, data are lacking. METHODS: We investigated estimated glomerular filtration rate (eGFR) on admission according to the Modification of Diet in Renal Disease equation in 958 consecutive patients aged 15 to 49 years with their first-ever ischemic stroke. Logistic regression adjusted for demographics and stroke risk factors served to identify factors related to low (<60) and high (>120 mL/min/1.73 m(2)) eGFR. In the long-term follow-up (mean, 8.9±3.8 years) study, Cox proportional hazards analysis described the association between eGFR and the following end points: nonfatal/fatal ischemic stroke; composite vascular event of any stroke, myocardial infarction, revascularization/other arterial occlusive event, or vascular death; and death of any cause. RESULTS: Estimated GFR was normal in 809 (84.4%), low in 43 (4.5%), and high in 106 (11.1%) patients. Type 1 diabetes (OR, 18.84; 95% CI, 8.65 to 41.03), hypertension (4.29; 1.94 to 9.48), and cardiovascular disease (2.66; 1.19 to 5.96) were independently associated with low eGFR. Type 2 diabetes (3.82; 1.93 to 7.55), lower age (0.95 per year; 0.93 to 0.98), and male gender (1.74; 1.08 to 2.82) were associated with high eGFR. Both low (hazard ratio, 5.73; 95% CI, 3.54 to 9.25) and high eGFR (1.78; 1.01 to 3.14) were associated with long-term mortality when adjusted for age, gender, risk factors, stroke severity, and subtype. No independent association appeared between eGFR and vascular events. CONCLUSIONS: Despite their different associated risk factors in our young patient cohort, both low and high eGFR predicted long-term mortality after ischemic stroke.
Authors:
Jukka Putaala; Elena Haapaniemi; Daniel Gordin; Ron Liebkind; Per-Henrik Groop; Markku Kaste; Turgut Tatlisumak
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-7
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland; the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland; and the Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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