Postgraduate medicine · 2025
Cumulative burden of estimated glomerular filtration rate and the risk of intracranial atherosclerosis: a prospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Wang Jinqi, Zhao Xiaoyu, Wang Jiahe, Liu Yueruijing, Li Yunfei, Zhao Yanchen, Jin Rui, Xu Zongkai, Wu Zhiyuan, Guo Xiuhua, Tao Lixin
Аннотация
BACKGROUND: Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke. The longitudinal association of the estimated glomerular filtration rate (eGFR) with ICAS is unclear. This study aimed to investigate the association of cumulative eGFR burden with incident ICAS.
METHODS: In this prospective cohort study, 4032 participants underwent baseline examinations in 2010-2011, 2012-2013, and 2014-2015 and were followed through 31 December 2021. Cumulative eGFR was calculated based on three consecutive measurements obtained from 2010 to 2015. The eGFR slope was estimated using a linear mixed-effects model with eGFR regressed on time from 2010 to 2015. The outcome was defined as the incident ICAS during 2016-2021.
RESULTS: The median follow-up time was 3.96 years, during which 374 participants (9.28%) developed ICAS. In the fully adjusted model, single-time-point eGFR < 90 mL/min/1.73 m² (OR: 1.817, 95% CI: 1.343, 2.459), cumulative eGFR burden > 0 (OR: 1.366, 95% CI: 1.041, 1.791), eGFR slope < -10 mL/min/1.73 m²/year (OR: 2.086, 95% CI: 1.480, 2.944), and exposure duration of reduced kidney function > 3 to ≤ 6 years (OR: 1.867, 95% CI: 1.329, 2.622) were significantly associated with increased ICAS risk. Cumulative eGFR burden had a higher net reclassification improvement and integrated discrimination improvement than single-time-point eGFR for predicting ICAS.
CONCLUSION: In this cohort study, single-time-point eGFR, cumulative eGFR burden, eGFR slope, and exposure duration of reduced kidney function were all associated with increased risk of ICAS. Notably, cumulative eGFR burden, which captures both the duration and magnitude of kidney function decline, demonstrated superior predictive value compared with single-time-point eGFR for identifying individuals at risk of ICAS.
METHODS: In this prospective cohort study, 4032 participants underwent baseline examinations in 2010-2011, 2012-2013, and 2014-2015 and were followed through 31 December 2021. Cumulative eGFR was calculated based on three consecutive measurements obtained from 2010 to 2015. The eGFR slope was estimated using a linear mixed-effects model with eGFR regressed on time from 2010 to 2015. The outcome was defined as the incident ICAS during 2016-2021.
RESULTS: The median follow-up time was 3.96 years, during which 374 participants (9.28%) developed ICAS. In the fully adjusted model, single-time-point eGFR < 90 mL/min/1.73 m² (OR: 1.817, 95% CI: 1.343, 2.459), cumulative eGFR burden > 0 (OR: 1.366, 95% CI: 1.041, 1.791), eGFR slope < -10 mL/min/1.73 m²/year (OR: 2.086, 95% CI: 1.480, 2.944), and exposure duration of reduced kidney function > 3 to ≤ 6 years (OR: 1.867, 95% CI: 1.329, 2.622) were significantly associated with increased ICAS risk. Cumulative eGFR burden had a higher net reclassification improvement and integrated discrimination improvement than single-time-point eGFR for predicting ICAS.
CONCLUSION: In this cohort study, single-time-point eGFR, cumulative eGFR burden, eGFR slope, and exposure duration of reduced kidney function were all associated with increased risk of ICAS. Notably, cumulative eGFR burden, which captures both the duration and magnitude of kidney function decline, demonstrated superior predictive value compared with single-time-point eGFR for identifying individuals at risk of ICAS.