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Innere Medizin 18. Jänner 2016

Ischemic stroke: the impact of renal dysfunction on 1-year mortality

Background: Atherosclerosis is accelerated in patients with different stages of chronic renal failure. Renal dysfunction predicts mortality in patients with myocardial infarction and congestive heart failure. Less is known about the impact of renal dysfunction on mortality after ischemic stroke. The aim of the study was to investigate the impact of renal dysfunction on 1-year mortality.

Patients and methods: All 390 patients (207 men and 183 women) suffered from ischemic stroke in 1-year period were included in our study. Telephonic follow-up after 1 year was performed. The mean age of our patients was 71.0 ± 11.6 years, ranged from 36 to 96 years. Glomerular filtration rate (GFR) was calculated according to abbreviated Modification of Diet in Renal Disease formula. At admission and at discharge National Institutes of Health Stroke Scale (NIHSS) were performed.

Results: The mean GFR in our patients was 66.0 ± 20.68 ml/min/1.73 m2. There were 123 (31.5 %) deaths in 1-year period. Patients who died were older (P < 0.001), had higher NIHSS at admission and at discharge (both P < 0.001), higher high-sensitive C-reactive protein (P = 0.002), lower albumin (P < 0.001), lower GFR (P = 0.044), had more frequent atrial fibrillation (P < 0.001), and were less frequent actual smokers (P = 0.003). No differences in presence of diabetes and hypertension, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides between patients who died or survived were found. With Cox multivariable regression analysis age (P = 0.037), gender (P = 0.005), NIHSS at admission (P = 0.005) and discharge (P < 0.001), albumin (P = 0.005) and also GFR (P = 0.025) were predictors of 1-year mortality.

Conclusions: In patients with ischemic stroke, renal dysfunction (decreased GFR) was associated with 1-year mortality. GFR was independent predictor of mortality.

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