Summary Aim: Chronic kidney disease is a global public health problem that is recognized as an established risk factor for stroke. It is unclear whether their distribution and clinical impact are consistent among ischemic stroke subtypes in patients with renal failure. We determined whether renal failure was associated with the proportion of each stroke subtype in the total ischemic stroke patients and was also associated with functional outcomes after each stroke subtype. Methods: The study subjects were 10,392 adult patients with acute stroke from the Japan Stroke Data Bank registry, a hospital-based multicenter stroke registry database, between October 2016 and December 2019, whose baseline levels of Serum creatinine and/or dipstick proteinuria were available. All ischemic strokes were classified according to the criteria of Trial of ORG 10172 in Acute Stroke Treatment. Unfavorable functional outcomes were defined as modified Rankin Scale (mRS) 3-6 at discharge. Mixed-effects logistic regression was used to determine the relationship between outcomes and estimated glomerular filtration rate (eGFR), eGFR strata (<45, 45-59, ≥60 ml/min/1.73 m2), or proteinuria with dipstick ≥1 adjusted for covariates. Results: Overall, 2419 (23%) patients had an eGFR of 45-59 ml/min/1.73 m2 and 1976 (19%) had an eGFR <45 ml/min/1.73 m2, including 185 patients (1, 8%) who received hemodialysis. Both eGFR 45-59 and eGFR <45 mL/min/1.73 m2 were associated with a higher proportion of cardioembolic stroke (odds ratio [OR], 1.21 [95% confidence intervals (CI)]. 1.05–1.39] and 1.55 [1.34 –1.79], respectively) and a lower proportion of small vessel occlusion (0.79 [0.69–0.90] and 0.68 [0.59-0.79], respectively). Similar association with the proportion of these two subtypes was demonstrated in analyzes using decreased eGFR as continuous values. Both eGFR <45 mL/min/1.73 m2 and proteinuria were associated with poor functional outcomes in patients with cardioembolic stroke (OR, 1.30 [95% CI, 1.01–1.69] and 3. 18 [2.03–4.98], respectively) and small vessel disease. occlusion (OR, 1.44 [1.01-2.07] and 2.08 [1.08-3.98], respectively). Conclusions: Renal failure contributes to the different distributions and clinical impacts in specific stroke subtypes, particularly evident in cardioembolic stroke and small vessel occlusion. This possibly indicates shared susceptibility mechanisms and potentially potentiating pathways. |
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When your kidneys talk about your heart
Researchers from the National Cerebral and Cardiovascular Center of Japan find that deterioration in kidney function is preferentially associated with specific stroke subtypes in a large cohort of patients from the Japan Stroke Data Bank.
“The foot bone is connected to the ankle bone,” goes the schoolyard song, highlighting the ways each part of our body can affect other parts of the body. Now, researchers in Japan have discovered that the kidney is connected to the heart, in the sense that kidney malfunction is associated with different types of strokes.
In a study published in March in Neurology, researchers at Japan’s National Cerebral and Cardiovascular Center (Kinya Otsu, president) found that patients who show indicators of poor kidney function are more likely to suffer a cardioembolic stroke, but less likely to suffer an occlusion of small blood vessels. than patients with normal kidney function.
Chronic kidney disease has a known link to stroke, with patients with kidney failure being twice as likely as healthy people to suffer a stroke. However, there are several different types of stroke and it is unclear whether poor kidney health makes people more susceptible to all types of stroke or whether it favors certain types.
“Other groups have explored the link between kidney failure and stroke,” explains Kaori Miwa, lead author, on behalf of researchers at the Japan Stroke Data Bank. "But the results were inconsistent, with some studies finding no significant association between these two conditions, and some studies showing a connection."
To resolve this controversy, researchers analyzed clinical data from more than 10,000 people from the Japan Stroke Data Bank , a national database of acute stroke patients. This multicenter, hospital-based registry has the advantage of including standardized clinical information, ensuring a valid stroke diagnosis, and involving acute management by stroke specialists.
"Using such a large and comprehensive database allowed us to definitively demonstrate that low filtration rates and high urinary protein levels are associated with cardioembolic stroke , while small vessel occlusion was less common in compared to other types of stroke," says Masatoshi Koga, second author of the paper.
In addition to increased risk of cardioembolic stroke, low filtration rate predicted disability after cardioembolic stroke, and both low filtration rate and high urinary protein levels were associated with a higher likelihood of dying during hospitalization. due to cerebrovascular accident.
“Our findings conclusively show that there is a statistically significant association between kidney failure and clinical outcomes after specific subtypes of ischemic stroke,” says Kazunori Toyoda, lead author of the paper.
Given that nearly 10% of the world’s population suffers from chronic kidney disease, the insights provided by this large-scale study could help predict stroke risk and ultimate prognosis in many of these patients. Understanding which subtype of stroke patients with kidney failure are likely to experience may be helpful in guiding preventive treatment.
