Correlation between chronic kidney disease and long-term outcome in patients with acute cerebral infarction

Abstract

Objective To investigate the correlation between chronic kidney disease (CKD) and long-term outcomes in a large cohort of unselected patients with acute cerebral infarction. Methods Consecutive acute cerebral infarction patients hospitalized in Department of Neurology, General Hospital of Jinan Military Region were prospectively recruited from August 2010 to November 2013. The baseline data including age, sex, the National Institute of Health Stroke Scale (NIHSS) scores, type of Oxfordshire Community Stroke Project(OCSP: total anterior circulation infarct, partial anterior circulation infart, posterior circulation infarct and lacunar infarct), serum creatinine were recorded. Estimated glomerular filtration rate (eGFR) was calculated according to CKD epidemiology collaboration (CKD-EPI) equation. CKD was defined as eGFR 2 reflected unfavorable prognosis). Multinominal Logistic regression analysis, Kaplan-Meier curve and log rank test were used. Results Eight hundred and fifty-two patients were enrolled, among them 93 patients were with CKD. Compared to patients without CKD, acute ischemic patients with CKD were older ((70.56±11.86) years vs (63.11±12.15) years, t=5.60, P=0.000), more likely with NIHSS≥7(59.14% (55/93) vs 32.54% (247/759), χ2=25.61, P=0.000), more likely with hypertension (89.25% (83/93) vs 77.34% (587/759), χ2=6.99, P=0.007), more likely with atrial fibrillation (29.03% (27/93) vs 9.5% (72/759), χ2=30.82, P=0.000), more likely with congestive heart failure (13.98% (13/93) vs 3.03% (23/759), χ2=24.54, P=0.000), more likely with tumour (6.50%(6/93) vs 2.24% (17/759), χ2=5.59, P=0.031). CKD was a independent prognostic factor for long-term poor outcome (OR=2.034, 95% CI 1.194-3.468)and long term mortality (OR=2.657, 95% CI 1.450-4.870). Kaplan-Meier estimate of patients without CKD for cumulative 180 days survival function for all-cause mortality was higher than those with CKD (79.57% (74/93) vs 93.54% (710/759), Log rank test: χ2=23.602, P=0.000). Conclusions Acute ischemic stroke patients with CKD are with more comorbidities. CKD is a independent prognostic factor for long-term poor outcomes and long term mortality in patients with acute cerebral infarction. (Clinical Research Center of China (ChiCTR-POC-15005912)) Key words: Renal insufficiency, chronic; Brain infarction; Prognosis