David Pereg1, Zach Rozenbaum2, Dina Vorobeichik3, Nir Shlomo3, Ronit Gilad4, Sivan Bloch5, Morris Mosseri6, David Tanne7. 1. Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; Department of Neurology, Carmel Medical Center, Haifa, Israel. Electronic address: davidpe@post.tau.ac.il. 2. Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Israel. 3. Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel HaShomer, Israel. 4. Department of Neurology, Kaplan Medical Center, Rehovot, Israel. 5. Department of Neurology, Carmel Medical Center, Haifa, Israel. 6. Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel. 7. Sackler Faculty of Medicine, Tel Aviv University, Israel; Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel HaShomer, Israel.
Abstract
BACKGROUND: Unrecognized renal dysfunction, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) in the presence of normal serum creatinine levels, is a common comorbidity among patients with various cardiovascular conditions. The current study was aimed to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients with acute stroke. METHODS: The cohort consisted of patients with acute stroke included in the prospective National Acute Stroke ISraeli (NASIS) registry. Unrecognized renal insufficiency was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) in the presence of serum creatinine ≤1.2 mg/dL. The 2 primary outcomes were in-hospital mortality and the composite of in-hospital mortality or severe disability at hospital discharge. RESULTS: Of the 7900 patients with stroke included in the study, 5571 (70.5%) had normal renal function, 1510 (19.1%) had recognized renal insufficiency, and 819 (10.4%) had unrecognized renal insufficiency. Mortality rates were higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (9.9%, 9.1%, and 4.4%, respectively, P < .0001). Adjusted odds ratios (ORs) for in-hospital mortality were higher for patients with renal dysfunction recognized (OR, 2.1; 95% confidence interval [CI], 1.6-2.7; P < .001) or unrecognized (OR, 1.6; 95% CI, 1.1-2.2; P = .006) compared with patients with normal renal function. Likewise, adjusted ORs for the composite of in-hospital mortality or severe disability at hospital discharge were higher for patients with renal dysfunction recognized (OR, 1.3; 95% CI, 1.1-1.5; P = .004) or unrecognized (OR, 1.2; 95% CI, 1.01-1.5; P = .04). CONCLUSIONS: Unrecognized renal insufficiency is common among patients with acute stroke and is associated with adverse short-term outcomes.
BACKGROUND: Unrecognized renal dysfunction, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) in the presence of normal serum creatinine levels, is a common comorbidity among patients with various cardiovascular conditions. The current study was aimed to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients with acute stroke. METHODS: The cohort consisted of patients with acute stroke included in the prospective National Acute Stroke ISraeli (NASIS) registry. Unrecognized renal insufficiency was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) in the presence of serum creatinine ≤1.2 mg/dL. The 2 primary outcomes were in-hospital mortality and the composite of in-hospital mortality or severe disability at hospital discharge. RESULTS: Of the 7900 patients with stroke included in the study, 5571 (70.5%) had normal renal function, 1510 (19.1%) had recognized renal insufficiency, and 819 (10.4%) had unrecognized renal insufficiency. Mortality rates were higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (9.9%, 9.1%, and 4.4%, respectively, P < .0001). Adjusted odds ratios (ORs) for in-hospital mortality were higher for patients with renal dysfunction recognized (OR, 2.1; 95% confidence interval [CI], 1.6-2.7; P < .001) or unrecognized (OR, 1.6; 95% CI, 1.1-2.2; P = .006) compared with patients with normal renal function. Likewise, adjusted ORs for the composite of in-hospital mortality or severe disability at hospital discharge were higher for patients with renal dysfunction recognized (OR, 1.3; 95% CI, 1.1-1.5; P = .004) or unrecognized (OR, 1.2; 95% CI, 1.01-1.5; P = .04). CONCLUSIONS: Unrecognized renal insufficiency is common among patients with acute stroke and is associated with adverse short-term outcomes.
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Authors: Renate B Schnabel; Stephan Camen; Fabian Knebel; Andreas Hagendorff; Udo Bavendiek; Michael Böhm; Wolfram Doehner; Matthias Endres; Klaus Gröschel; Andreas Goette; Hagen B Huttner; Christoph Jensen; Paulus Kirchhof; Grigorios Korosoglou; Ulrich Laufs; Jan Liman; Caroline Morbach; Darius Günther Nabavi; Tobias Neumann-Haefelin; Waltraud Pfeilschifter; Sven Poli; Timolaos Rizos; Andreas Rolf; Joachim Röther; Wolf Rüdiger Schäbitz; Thorsten Steiner; Götz Thomalla; Rolf Wachter; Karl Georg Haeusler Journal: Clin Res Cardiol Date: 2021-06-18 Impact factor: 5.460