Association of glomerular filtration rate with outcomes of acute stroke in type 2 diabetic patients: results from the China National Stroke Registry

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From: Diabetes Care(Vol. 37, Issue 1)
Publisher: American Diabetes Association
Document Type: Article
Length: 3,590 words
Lexile Measure: 1610L

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OBJECTIVE

We aim to explore whether a link exists between different levels of estimated glomerular filtration rate (eGFR) and poor outcomes of acute stroke in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Between 2007 and 2009, 6,261 patients with cerebrovascular events and diabetes were included in the final analysis from the China National Stroke Registry (CNSR) and substudy of CNSR (Abnormal Glucose Regulation in Patients with Acute Stroke Across China [ACROSS]).The period of follow-up was 1 year after stroke onset. eGFR was calculated with the Chinese modification of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The association between eGFR and poor stroke outcomes, including all-cause death, recurrent stroke, combined end point (stroke or death), and stroke disability, was evaluated by multivariate analysis with the adjustment for demographic and clinical features.

RESULTS

Of 4,836 patients with stroke, low eGFR (<45 mL/min/1.73 [m.sup.2]) occurred in 268 (5.5%) and high eGFR ([greater than or equal to] 120 mL/min/1.73 [m.sup.2]) in 387 (8.0%). The median value for eGFR in all patients was 92.6 mL/min/1.73 [m.sup.2]. Low eGFR was independently associated with risks of all clinical outcomes in stroke/transient ischemic attack patients or patients with ischemic events, but not in patients with hemorrhagic stroke. Additionally, high eGFR was positively associated with an increased risk of adverse outcomes in all stroke subtypes, including hemorrhagic stroke.

CONCLUSIONS

Low and high eGFRs (<45 or [greater than or equal to] 120 mL/min/1.73 [m.sup.2], respectively) are independent predictors of all-cause mortality and other poor outcomes after acute stroke in patients with type 2 diabetes.

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Chronic kidney disease (CKD) is a worldwide public health problem with an estimated prevalence of 20.8% in Chinese adults (1-3). Growing evidence has demonstrated an association between impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 [m.sup.2], and all-cause mortality and other adverse cardiovascular outcomes in the general population (4-6). A recent meta-analysis showed that low eGFR was independently associated with incidence of stroke across a variety of participants, including Chinese stroke patients from Taiwan (7). However, the impact of low eGFR on stroke-related outcomes remains controversial (8,9). As the prevalence of stroke keeps increasing in China in recent years (10), it is very important to know the impact of reduced eGFR on adverse outcomes of stroke in Chinese patients.

Diabetes is another important public health problem in China, with an age-standardized prevalence of 9.7% (11). It is not only demonstrated as an independent risk factor for the incidence of stroke but is also proven to be a predictor for stroke outcomes among different ethnic groups (7,12). However, the effects of reduced eGFR on all-cause mortality or stroke recurrence and disability after acute stroke among diabetic patients have not been clarified (12,13). In this study, we systemically investigated whether a link exists between different levels of eGFR, calculated with the Chinese modification of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and poor outcomes of acute stroke in a nationally representative cohort of acute stroke patients with type 2 diabetes.

RESEARCH DESIGN...

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Gale Document Number: GALE|A355558093