Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration.
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Molad Jeremy, Miwa Kaori, Nash Philip S, Ambler Gareth, Best Jonathan, Wilson Duncan, Hallevi Hen, Fandler-Höfler Simon, Eppinger Sebastian, Du Houwei, Al-Shahi Salman Rustam, Jäger Hans R, Lip Gregory Y H, Goeldlin Martina B, Beyeler Morin, Bücke Philipp, El-Koussy Marwan, Mattle Heinrich Paul, Panos Leonidas D, van Dam-Nolen Dianne H K, Dubost Florian, Hendrikse Jeroen, Kooi M Eline, Mess Werner, Nederkoorn Paul J, Shiozawa Masayuki, Christ Nicolas, Bellut Maximilian, Gunkel Sarah, Karayiannis Christopher, Van Ly John, Singhal Shaloo, Slater Lee-Anne, Kim Young Dae, Song Tae-Jin, Lee Keon-Joo, Lim Jae-Sung, Hara Hideo, Nishihara Masashi, Tanaka Jun, Yoshikawa Masaaki, Demirelli Derya Selcuk, Tanriverdi Zeynep, Uysal Ender, Coutts Shelagh B, Chappell Francesca M, Makin Stephen, Mak Henry Ka-Fung, Teo Kay Cheong, Wong Debbie Y K, Hert Lisa, Kubacka Marta, Lyrer Philippe, Polymeris Alexandros A, Wagner Benjamin, Zietz Annaelle, Abrigo Jill M, Cheng Cyrus, Chu Winnie C W, Leung Thomas W H, Tsang Suk Fung, Yiu Brian, Seiffge David J, Fischer Urs, Jung Simon, Enzinger Christian, Gattringer Thomas, Bos Daniel, Toyoda Kazunori, Fluri Felix, Phan Thanh G, Srikanth Velandai, Heo Ji Hoe, Bae Hee-Joon, Yakushiji Yusuke, Orken Dilek Necioglu, Smith Eric E, Wardlaw Joanna M, Lau Kui Kai, Engelter Stefan T, Peters Nils, Soo Yannie, Wheeler David C, Simister Robert J, Bornstein Natan M, Werring David J, Ben Assayag Einor, Koga Masatoshi
Аннотация
METHODS: We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity.
RESULTS: 11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) -2.10 mL/min/1.73 cm2 (95% CI -3.39 to -0.81)) and mixed microbleeds (aMD -2.42 (95% CI -3.70 to -1.15)), but not strictly deep microbleeds (aMD -0.67 (95% CI -1.85 to 0.51)).
CONCLUSIONS: In patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.