SUN-284 STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE

Abstract

STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE Unrecognized renal insufficiency, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the presence of normal serum creatinine levels, is a common co morbid condition among patients with various cardiovascular conditions. Epidemiological study demonstrated that renal insufficiency forecast long-term mortality and hence can be used to stratify risk for stroke patients. Our purpose of study is to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients admitted with acute stroke. STUDY DESIGN: Cross sectional prospective study. STUDY DURATION: March 2017 to August 2017. INCLUSION CRITERIA: All patients admitted with acute stroke . EXCLUSION CRITERIA: Acute stroke in < 18 years ,Head injury. MATERIAL & METHODS: Our study group consisted of 100 patients with acute stroke admitted in Stanley Medical College. The detailed history of the patients has been recorded and patients underwent a detailed clinical examination. Appropiate investigations were done. The estimated glomerular filtration rate is calculated using the MDRD and CKD-EPI equation. The study groups are stratified into 3 groups according to the renal function assessment (normal renal Function, unrecognized renal insufficiency and recognized renal insufficiency). Out of the 100 patients with acute stroke included in the study, 62 have normal renal function, 31 have recognized renal insufficiency, and 7 have unrecognized renal insufficiency. Majority of the study subjects in normal renal function group were males (n=48), females in unrecognized renal insufficiency group (n=7) and males in recognized renal insufficiency group (n=24). Using single factor ANOVA test, age distribution,the mean difference of blood urea values and serum creatinine values, the mean difference of MDRD values and CKD-EPI values, the mean difference of systolic blood pressure and diastolic blood pressure ,the mean difference of hemoglobin, the mean difference of random blood sugar values were found to be statistically significant (p <0.05). Using fishers exact test,the difference in percentage of females, the difference in percentage of diabetics, the difference in percentage of subjects with dyslipidemia were found to be statistically significant (p < 0.05) In our study, modified Rankin score(MRS) was significantly higher in patients with recognized renal insufficiency compared to unrecognized renal insufficiency patients. Mortality rates are higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (29%, 28.5% and 9.6% respectively, p< 0.05). Severe disability rates at discharge are also higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (72.27%, 80 %, and 32.14%) respectively, p<0.05. 1. Unrecognized renal insufficiency is found to be a common co morbidity among patients with acute stroke in our study.2. Unrecognized renal insufficiency is significantly common among older age group and more frequently in females compared to male in our study group. 3. Mortality rate and severe disability rate are higher in patients with recognized and unrecognized renal insufficiency compared to patients with normal renal function.