484Reduced glomerular filtration rate and risk of stroke

Abstract

Abstract Background Although chronic kidney disease is recognized as an independent risk factor for cerebrovascular disease, its association with hemorrhagic and ischemic stroke remains controversial. Methods A retrospective cohort study conducted using the National Health Insurance Service-National Sample Cohort, which is representative of the entire Korean population. Overall, 196,005 Korean who were not diagnosed with ischemic and hemorrhagic stroke before 2009 were included from 2009 to 2013. The eGFR was divided into six categories (≥90, 75–89, 60–74, 45–59, 30–44, <30 mL/min/1.73 m2). The Kaplan-Meier plot was illustrated to compare the cumulative incidence of ischemic stroke and hemorrhagic stroke. Cox proportional hazard model was used to estimate the hazard ratio (HR) of eGFR for risk of ischemic and hemorrhagic stroke. Results During an average of 4.36 years follow-up period, 2,236 and 668 people were diagnosed with newly ischemic stroke and hemorrhagic stroke, respectively. Among people with eGFR>90 mL/min/1.73 m2, age and sex adjusted incidence rate for ischemic stroke was 452.3 per 100,000 person-years, whereas the adjusted incidence rate for ischemic stroke among people eGFR with 30-44 and 45 mL/min/1.73m2 was 833.5 and 617.7 per 100,000 person-years, respectively. After adjusting for multiple covariates, the adjusted HR for ischemic stroke increased with decreasing eGFR (p for trend=0.005). However, there was no significant dose-response relationship between eGFR and risk of hemorrhagic stroke. Conclusions Reduced glomerular filtration rate less than 45 mL/min/1.73 m2 was associated with an increased risk of ischemic stroke but not hemorrhagic stroke. Key messages Reduction in kidney function had inverse dose-response relationship with the risk of ischemic stroke, but not with the hemorrhagic stroke. Especially, the risk of ischemic stroke was markedly increased from estimated glomerular filtration rate < 45 mL/min/1.73 m2.