Abstract
BackgroundChronic kidney disease (CKD) is associated to a higher stroke risk. Anemia is a common consequence of CKD, and is also a possible risk factor for cerebrovascular diseases. The purpose of this study was to examine if anemia and CKD are independent risk factors for mortality after stroke.MethodsThis historic cohort study was based on a stroke registry and included patients treated for a first clinical stroke in the stroke unit of one academic hospital over a three-year period. Mortality predictors comprised demographic characteristics, CKD, glomerular filtration rate (GFR), anemia and other stroke risk factors. GFR was estimated by means of the simplified Modification of Diet in Renal Disease formula. Renal function was assessed according to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification in five groups. A value of hemoglobin < 120 g/L in women and < 130 g/L in men on admission defined anemia. Kaplan-Meier survival curves and Cox models were used to describe and analyze one-year survival.ResultsAmong 890 adult stroke patients, the mean (Standard Deviation) calculated GFR was 64.3 (17.8) ml/min/1.73 m2 and 17% had anemia. Eighty-two (10%) patients died during the first year after discharge. Among those, 50 (61%) had K/DOQI CKD stages 3 to 5 and 32 (39%) stages 1 or 2 (p < 0.001). Anemia was associated with an increased risk of death one year after discharge (p < 0.001). After adjustment for other factors, a higher hemoglobin level was independently associated with decreased mortality one year after discharge [hazard ratio (95% CI) 0.98 (0.97-1.00)].ConclusionsBoth CKD and anemia are frequent among stroke patients and are potential risk factors for decreased one-year survival. The inclusion of patients with a first-ever clinical stroke only and the determination of anemia based on one single measure, on admission, constitute limitations to the external validity. We should investigate if an early detection and management of both CKD and anemia could improve survival in stroke patients.
Highlights
Stroke is an increasing cause of mortality and severe neurological disability, including late-life dementia, worldwide [1,2,3]
When anemia was present with chronic kidney disease, the risk of stroke increased clearly compared to patients with Chronic kidney disease (CKD) without anemia, in which the risk of stroke was only moderately increased
Other variables included the presence of ischemic heart disease and atrial fibrillation, peripheral arterial insufficiency, a positive family history for stroke and/or heart disease and transient ischemic attack (TIA: a neurological disorder due to a temporary ischemia of the brain which lasts less than 24 hours)
Summary
Stroke is an increasing cause of mortality and severe neurological disability, including late-life dementia, worldwide [1,2,3]. When anemia was present with chronic kidney disease, the risk of stroke increased clearly compared to patients with CKD without anemia, in which the risk of stroke was only moderately increased. Among those patients with anemia and low creatinine clearance the crude stroke rate per 1000 person-years was 10.53 and, among those without anemia and low creatinine clearance, the rate was 2.85 [6]. To further study the role of CKD and anemia on outcome in stroke patients, the objective of this study was to examine the association between chronic kidney disease and anemia with in-hospital mortality and one-year survival among hospitalized stroke patients. The purpose of this study was to examine if anemia and CKD are independent risk factors for mortality after stroke
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