Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack
Background and purpose Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk p...
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| Veröffentlicht in: | European journal of neurology 2022-09, Vol.29 (9), p.2716-2724 |
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| creator | Tütüncü, Serdar Olma, Manuel C. Kunze, Claudia Krämer, Michael Dietzel, Joanna Schurig, Johannes Filser, Paula Pfeilschifter, Waltraud Hamann, Gerhard F. Büttner, Thomas Heuschmann, Peter U. Kirchhof, Paulus Laufs, Ulrich Nabavi, Darius G. Röther, Joachim Thomalla, Götz Veltkamp, Roland Eckardt, Kai‐Uwe Haeusler, Karl Georg Endres, Matthias |
| description | Background and purpose
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m2. eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m2), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m2), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m2), and “stable decreased” ( |
| doi_str_mv | 10.1111/ene.15431 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2672704751</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2672704751</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3481-20b0cb3aaf2eeb8b025bd1c03e97ebccf3a963becf1332e5ca96894454fe99913</originalsourceid><addsrcrecordid>eNp1kctu2zAQRYkiQe06WeQHAgLZpAvFfIiWtCwC9wEYyaZdCxQ1iplIpEtSMfwz_daOH82iQLiZ4fDMxXAuIVec3XE8c3Bwx1Uu-Qcy5fmizLiU_AxzqXimOOMT8inGZ8aYKAT7SCZSLZQo8mJK_qzgFfpItWtpu3N6sCZS31GIyQ46QUufej9AGHsdaGf7FHSy3lEMcGgKYMYQwCX6qqM5YKjo0kkSdFpT6-gG2w7VrcXCYJ0PNKbgX4Bihqou7t-pjWYNOATVKWnzckHOO91HuDzFGfn1dfnz_nu2evz24_7LKjMyL3kmWMNMI7XuBEBTNkyopuWGSagKaIzppK4WsgHT4WYEKIPXsspzlXdQVRWXM3J71N0E_3vEz9cDTgJ9rx34MdZiUYiC5YXaozf_oc9-DA6nQ6oqZYk-SKQ-HykTfIwBunoTcKFhV3NW702r0bT6YBqy1yfFsRmgfSP_uYTA_AhsbQ-795Xq5cPyKPkXvS6kZQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2698384313</pqid></control><display><type>article</type><title>Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Tütüncü, Serdar ; Olma, Manuel C. ; Kunze, Claudia ; Krämer, Michael ; Dietzel, Joanna ; Schurig, Johannes ; Filser, Paula ; Pfeilschifter, Waltraud ; Hamann, Gerhard F. ; Büttner, Thomas ; Heuschmann, Peter U. ; Kirchhof, Paulus ; Laufs, Ulrich ; Nabavi, Darius G. ; Röther, Joachim ; Thomalla, Götz ; Veltkamp, Roland ; Eckardt, Kai‐Uwe ; Haeusler, Karl Georg ; Endres, Matthias</creator><creatorcontrib>Tütüncü, Serdar ; Olma, Manuel C. ; Kunze, Claudia ; Krämer, Michael ; Dietzel, Joanna ; Schurig, Johannes ; Filser, Paula ; Pfeilschifter, Waltraud ; Hamann, Gerhard F. ; Büttner, Thomas ; Heuschmann, Peter U. ; Kirchhof, Paulus ; Laufs, Ulrich ; Nabavi, Darius G. ; Röther, Joachim ; Thomalla, Götz ; Veltkamp, Roland ; Eckardt, Kai‐Uwe ; Haeusler, Karl Georg ; Endres, Matthias ; MonDAFIS Investigators</creatorcontrib><description>Background and purpose
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m2. eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m2), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m2), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m2), and “stable decreased” (<60 ml/min/1.73 m2). The composite endpoint (stroke, major bleeding, myocardial infarction, all‐cause death) was assessed after 24 months. We estimated hazard ratios in confounder‐adjusted models.
Results
Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m2 at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all‐cause death (HR = 3.12, 95% CI = 1.63–5.98).
Conclusions
In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
Lower levels of single point estimated glomerular filtration rate (eGFR) at baseline in acute stroke patients predict worse outcomes. Whether repeated eGFR measurements add relevant information for risk prediction was unclear. In a post hoc analysis of a stroke cohort with existing follow‐up measurement of eGFR in‐hospital, we found a significantly higher risk for recurrent vascular events and mortality in patients with decreasing eGFR of at least 15% from a baseline value of ≥60 ml/min/1.73 m2 compared to those with stable normal eGFR.</description><identifier>ISSN: 1351-5101</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.15431</identifier><identifier>PMID: 35652747</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Atrial Fibrillation - complications ; Cardiovascular diseases ; Cerebral infarction ; Confidence intervals ; Death ; EKG ; Electrocardiography ; Epidermal growth factor receptors ; Fibrillation ; Glomerular Filtration Rate ; Health hazards ; Health risks ; Humans ; Ischemia ; Ischemic Attack, Transient - complications ; Ischemic Stroke ; kidney function ; Mortality ; Myocardial infarction ; Patients ; prognosis ; Risk analysis ; Risk Factors ; Stroke ; Stroke - complications ; Transient ischemic attack</subject><ispartof>European journal of neurology, 2022-09, Vol.29 (9), p.2716-2724</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3481-20b0cb3aaf2eeb8b025bd1c03e97ebccf3a963becf1332e5ca96894454fe99913</cites><orcidid>0000-0001-6935-8842 ; 0000-0002-5057-7487</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.15431$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.15431$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35652747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tütüncü, Serdar</creatorcontrib><creatorcontrib>Olma, Manuel C.</creatorcontrib><creatorcontrib>Kunze, Claudia</creatorcontrib><creatorcontrib>Krämer, Michael</creatorcontrib><creatorcontrib>Dietzel, Joanna</creatorcontrib><creatorcontrib>Schurig, Johannes</creatorcontrib><creatorcontrib>Filser, Paula</creatorcontrib><creatorcontrib>Pfeilschifter, Waltraud</creatorcontrib><creatorcontrib>Hamann, Gerhard F.</creatorcontrib><creatorcontrib>Büttner, Thomas</creatorcontrib><creatorcontrib>Heuschmann, Peter U.</creatorcontrib><creatorcontrib>Kirchhof, Paulus</creatorcontrib><creatorcontrib>Laufs, Ulrich</creatorcontrib><creatorcontrib>Nabavi, Darius G.</creatorcontrib><creatorcontrib>Röther, Joachim</creatorcontrib><creatorcontrib>Thomalla, Götz</creatorcontrib><creatorcontrib>Veltkamp, Roland</creatorcontrib><creatorcontrib>Eckardt, Kai‐Uwe</creatorcontrib><creatorcontrib>Haeusler, Karl Georg</creatorcontrib><creatorcontrib>Endres, Matthias</creatorcontrib><creatorcontrib>MonDAFIS Investigators</creatorcontrib><title>Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background and purpose
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m2. eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m2), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m2), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m2), and “stable decreased” (<60 ml/min/1.73 m2). The composite endpoint (stroke, major bleeding, myocardial infarction, all‐cause death) was assessed after 24 months. We estimated hazard ratios in confounder‐adjusted models.
Results
Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m2 at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all‐cause death (HR = 3.12, 95% CI = 1.63–5.98).
Conclusions
In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
Lower levels of single point estimated glomerular filtration rate (eGFR) at baseline in acute stroke patients predict worse outcomes. Whether repeated eGFR measurements add relevant information for risk prediction was unclear. In a post hoc analysis of a stroke cohort with existing follow‐up measurement of eGFR in‐hospital, we found a significantly higher risk for recurrent vascular events and mortality in patients with decreasing eGFR of at least 15% from a baseline value of ≥60 ml/min/1.73 m2 compared to those with stable normal eGFR.</description><subject>Atrial Fibrillation - complications</subject><subject>Cardiovascular diseases</subject><subject>Cerebral infarction</subject><subject>Confidence intervals</subject><subject>Death</subject><subject>EKG</subject><subject>Electrocardiography</subject><subject>Epidermal growth factor receptors</subject><subject>Fibrillation</subject><subject>Glomerular Filtration Rate</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemic Attack, Transient - complications</subject><subject>Ischemic Stroke</subject><subject>kidney function</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>prognosis</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - complications</subject><subject>Transient ischemic attack</subject><issn>1351-5101</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kctu2zAQRYkiQe06WeQHAgLZpAvFfIiWtCwC9wEYyaZdCxQ1iplIpEtSMfwz_daOH82iQLiZ4fDMxXAuIVec3XE8c3Bwx1Uu-Qcy5fmizLiU_AxzqXimOOMT8inGZ8aYKAT7SCZSLZQo8mJK_qzgFfpItWtpu3N6sCZS31GIyQ46QUufej9AGHsdaGf7FHSy3lEMcGgKYMYQwCX6qqM5YKjo0kkSdFpT6-gG2w7VrcXCYJ0PNKbgX4Bihqou7t-pjWYNOATVKWnzckHOO91HuDzFGfn1dfnz_nu2evz24_7LKjMyL3kmWMNMI7XuBEBTNkyopuWGSagKaIzppK4WsgHT4WYEKIPXsspzlXdQVRWXM3J71N0E_3vEz9cDTgJ9rx34MdZiUYiC5YXaozf_oc9-DA6nQ6oqZYk-SKQ-HykTfIwBunoTcKFhV3NW702r0bT6YBqy1yfFsRmgfSP_uYTA_AhsbQ-795Xq5cPyKPkXvS6kZQ</recordid><startdate>202209</startdate><enddate>202209</enddate><creator>Tütüncü, Serdar</creator><creator>Olma, Manuel C.</creator><creator>Kunze, Claudia</creator><creator>Krämer, Michael</creator><creator>Dietzel, Joanna</creator><creator>Schurig, Johannes</creator><creator>Filser, Paula</creator><creator>Pfeilschifter, Waltraud</creator><creator>Hamann, Gerhard F.</creator><creator>Büttner, Thomas</creator><creator>Heuschmann, Peter U.</creator><creator>Kirchhof, Paulus</creator><creator>Laufs, Ulrich</creator><creator>Nabavi, Darius G.</creator><creator>Röther, Joachim</creator><creator>Thomalla, Götz</creator><creator>Veltkamp, Roland</creator><creator>Eckardt, Kai‐Uwe</creator><creator>Haeusler, Karl Georg</creator><creator>Endres, Matthias</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6935-8842</orcidid><orcidid>https://orcid.org/0000-0002-5057-7487</orcidid></search><sort><creationdate>202209</creationdate><title>Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack</title><author>Tütüncü, Serdar ; Olma, Manuel C. ; Kunze, Claudia ; Krämer, Michael ; Dietzel, Joanna ; Schurig, Johannes ; Filser, Paula ; Pfeilschifter, Waltraud ; Hamann, Gerhard F. ; Büttner, Thomas ; Heuschmann, Peter U. ; Kirchhof, Paulus ; Laufs, Ulrich ; Nabavi, Darius G. ; Röther, Joachim ; Thomalla, Götz ; Veltkamp, Roland ; Eckardt, Kai‐Uwe ; Haeusler, Karl Georg ; Endres, Matthias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3481-20b0cb3aaf2eeb8b025bd1c03e97ebccf3a963becf1332e5ca96894454fe99913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Atrial Fibrillation - complications</topic><topic>Cardiovascular diseases</topic><topic>Cerebral infarction</topic><topic>Confidence intervals</topic><topic>Death</topic><topic>EKG</topic><topic>Electrocardiography</topic><topic>Epidermal growth factor receptors</topic><topic>Fibrillation</topic><topic>Glomerular Filtration Rate</topic><topic>Health hazards</topic><topic>Health risks</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemic Attack, Transient - complications</topic><topic>Ischemic Stroke</topic><topic>kidney function</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>prognosis</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - complications</topic><topic>Transient ischemic attack</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tütüncü, Serdar</creatorcontrib><creatorcontrib>Olma, Manuel C.</creatorcontrib><creatorcontrib>Kunze, Claudia</creatorcontrib><creatorcontrib>Krämer, Michael</creatorcontrib><creatorcontrib>Dietzel, Joanna</creatorcontrib><creatorcontrib>Schurig, Johannes</creatorcontrib><creatorcontrib>Filser, Paula</creatorcontrib><creatorcontrib>Pfeilschifter, Waltraud</creatorcontrib><creatorcontrib>Hamann, Gerhard F.</creatorcontrib><creatorcontrib>Büttner, Thomas</creatorcontrib><creatorcontrib>Heuschmann, Peter U.</creatorcontrib><creatorcontrib>Kirchhof, Paulus</creatorcontrib><creatorcontrib>Laufs, Ulrich</creatorcontrib><creatorcontrib>Nabavi, Darius G.</creatorcontrib><creatorcontrib>Röther, Joachim</creatorcontrib><creatorcontrib>Thomalla, Götz</creatorcontrib><creatorcontrib>Veltkamp, Roland</creatorcontrib><creatorcontrib>Eckardt, Kai‐Uwe</creatorcontrib><creatorcontrib>Haeusler, Karl Georg</creatorcontrib><creatorcontrib>Endres, Matthias</creatorcontrib><creatorcontrib>MonDAFIS Investigators</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tütüncü, Serdar</au><au>Olma, Manuel C.</au><au>Kunze, Claudia</au><au>Krämer, Michael</au><au>Dietzel, Joanna</au><au>Schurig, Johannes</au><au>Filser, Paula</au><au>Pfeilschifter, Waltraud</au><au>Hamann, Gerhard F.</au><au>Büttner, Thomas</au><au>Heuschmann, Peter U.</au><au>Kirchhof, Paulus</au><au>Laufs, Ulrich</au><au>Nabavi, Darius G.</au><au>Röther, Joachim</au><au>Thomalla, Götz</au><au>Veltkamp, Roland</au><au>Eckardt, Kai‐Uwe</au><au>Haeusler, Karl Georg</au><au>Endres, Matthias</au><aucorp>MonDAFIS Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2022-09</date><risdate>2022</risdate><volume>29</volume><issue>9</issue><spage>2716</spage><epage>2724</epage><pages>2716-2724</pages><issn>1351-5101</issn><eissn>1468-1331</eissn><abstract>Background and purpose
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m2. eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m2), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m2), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m2), and “stable decreased” (<60 ml/min/1.73 m2). The composite endpoint (stroke, major bleeding, myocardial infarction, all‐cause death) was assessed after 24 months. We estimated hazard ratios in confounder‐adjusted models.
Results
Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m2 at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all‐cause death (HR = 3.12, 95% CI = 1.63–5.98).
Conclusions
In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
Lower levels of single point estimated glomerular filtration rate (eGFR) at baseline in acute stroke patients predict worse outcomes. Whether repeated eGFR measurements add relevant information for risk prediction was unclear. In a post hoc analysis of a stroke cohort with existing follow‐up measurement of eGFR in‐hospital, we found a significantly higher risk for recurrent vascular events and mortality in patients with decreasing eGFR of at least 15% from a baseline value of ≥60 ml/min/1.73 m2 compared to those with stable normal eGFR.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>35652747</pmid><doi>10.1111/ene.15431</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6935-8842</orcidid><orcidid>https://orcid.org/0000-0002-5057-7487</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Atrial Fibrillation - complications Cardiovascular diseases Cerebral infarction Confidence intervals Death EKG Electrocardiography Epidermal growth factor receptors Fibrillation Glomerular Filtration Rate Health hazards Health risks Humans Ischemia Ischemic Attack, Transient - complications Ischemic Stroke kidney function Mortality Myocardial infarction Patients prognosis Risk analysis Risk Factors Stroke Stroke - complications Transient ischemic attack |
| title | Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack |
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