Association between reduced kidney function and clinical outcomes after ischaemic stroke with atrial fibrillation

Abstract

Atrial fibrillation (AF) can cause up to 50% of cardioembolic strokes and its effects may be exacerbated by chronic kidney disease. Our aim was to investigate the influence of reduced renal function on death, disability and stroke recurrence in stroke patients with AF in China. In this prospective study, patients with ischaemic stroke and AF who were admitted within 1 month of stroke onset between January 2003 and February 2007 were consecutively enrolled. Patients were classified as having a reduced estimated glomerular filtration rate (eGFR) or normal eGFR, and clinical characteristics, functional outcomes and stroke recurrence were compared between the two groups. A total of 229 patients were analyzed in the study, of whom 105 (45.9%) had reduced eGFR. These patients were more likely to be female, non-smokers and non-drinkers than were patients in the normal eGFR group (all P ≤ 0.002). Patients with reduced eGFR showed approximately 2-fold higher risk of death at 3, 6 and 12 months after stroke onset than did patients with normal eGFR (all P ≤ 0.042), after adjusting for age, sex and stroke severity on admission. However, the two groups showed similar 1-year cumulative stroke recurrence (P = 0.331, log rank test). Reduced eGFR was independently associated with increased risk of death in patients with ischaemic stroke and AF. The association between reduced eGFR and risk of stroke recurrence needs to be explored in larger studies.