Associations Between Estimated Glomerular Filtration Rate and Stroke Outcomes in Diabetic Versus Nondiabetic Patients
How does diabetes mellitus impact the association between estimated glomerular filtration rate (eGFR) and prognosis of acute stroke?
This was a prospective cohort study of Chinese patients with acute ischemic or hemorrhagic stroke enrolled in the following two studies between 2007 and 2009: the China National Stroke Registry (CNSR) and Abnormal Glucose Regulation in Patients with Acute Stroke Across China (ACROSS). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Patients were followed for 1 year for the following outcomes: all-cause mortality, stroke recurrence, and stroke disability.
The analytic sample included 17,280 patients (12,498 nondiabetics and 4,782 diabetics). Among nondiabetic patients and as compared with eGFR of 90-119 ml/min per 1.73 m2, the adjusted odds ratios (ORs) of eGFR<45 ml/min per 1.73 m2 were 2.79 (95% confidence interval [CI], 2.09-3.73) for all-cause mortality, 2.28 (95% CI, 1.74-2.98) for stroke recurrence, and 1.53 (95% CI, 1.16-2.01) for stroke disability. Higher GFR (≥120 ml/min per 1.73 m2) was also significantly associated with higher risk of all-cause mortality (OR, 1.38; 95% CI, 1.02-1.86). In diabetics, the adjusted ORs of all-cause mortality, stroke recurrence, and stroke disability in lower eGFR of <45 ml/min/1.73 m2 were 2.16 (1.51-3.08), 1.43 (1.02-2.00), and 1.38 (0.98-1.95). In diabetics, the adjusted ORs of all-cause mortality, stroke recurrence, and stroke disability in higher eGFR were 2.55 (1.75-3.74), 1.57 (1.13-2.18), and 1.89 (1.41-2.53), respectively.
Decreased eGFR was associated with all-cause mortality, stroke recurrence, and stroke disability in diabetics and nondiabetics. Increased eGFR was associated with all adverse outcomes of interest in diabetics, but was only linked to all-cause mortality in nondiabetics.
The limitations and generalizability of this national cohort study of Chinese patients aside, this analysis provides valuable insight on associations between low eGFR and stroke outcomes in both diabetics and nondiabetics. Although high GFR was associated with all three adverse outcomes of interest in diabetics, this should be interpreted with caution given the possible confounding effect of lower muscle mass, as the authors acknowledge. Nonetheless, renal insufficiency may be an important factor to consider when predicting prognosis following stroke in both diabetics and nondiabetics.
Keywords: Prognosis, Odds Ratio, Registries, Stroke, China, Glomerular Filtration Rate, Confidence Intervals, Creatinine, Diabetes Mellitus, Renal Insufficiency, Chronic, Glucose
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