TY - JOUR

T1 - Renal Impairment and Risk of Acute Stroke

T2 - The INTERSTROKE Study

AU - Smyth, Andrew

AU - Judge, Conor

AU - Wang, Xingu

AU - Pare, Guillaume

AU - Rangarajan, Sumathy

AU - Canavan, Michelle

AU - Chin, Siu Lim

AU - Al-Hussain, Fawaz

AU - Yusufali, Afzalhussein M.

AU - Elsayed, Ahmed

AU - Damasceno, Albertino

AU - Avezum, Alvaro

AU - Czlonkowska, Anna

AU - Rosengren, Annika

AU - Dans, Antonio L.

AU - Oguz, Aytekin

AU - Mondo, Charles

AU - Weimar, Christian

AU - Ryglewicz, Danuta

AU - Xavier, Denis

AU - Lanas, Fernando

AU - Malaga, German

AU - Hankey, Graeme J.

AU - Iversen, Helle K.

AU - Zhang, Hongye

AU - Yusoff, Khalid

AU - Pogosova, Nana

AU - Lopez-Jamarillo, Patricio

AU - Langhorne, Peter

AU - Diaz, Rafael

AU - Oveisgharan, Shahram

AU - Yusuf, Salim

AU - O'Donnell, Martin

N1 - Funding Information: The INTERSTROKE study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, and The Health & Medical Care Committee of the Regional Executive Board, Region Västra Göta-land (Sweden), and through unrestricted grants from several pharmaceutical companies with major contributions from AstraZene- ca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest Heart and Stroke Scotland, and the Stroke Association, with support from The UK Stroke Research Network. The Department of Neurology at the University Duisburg-Essen received research grants awarded from the German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, National Institutes of Health, Bertelsmann Foundation, and Heinz-Nixdorf Foundation. Publisher Copyright: © 2021

PY - 2021/6/1

Y1 - 2021/6/1

N2 - Background: Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association. Aims: We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations. Methods: INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke. Results: Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24-1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35-1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17-1.42) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50-3.54 for death within 1 month). Conclusion: Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.

AB - Background: Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association. Aims: We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations. Methods: INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke. Results: Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24-1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35-1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17-1.42) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50-3.54 for death within 1 month). Conclusion: Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.

KW - Kidney disease

KW - Stroke

U2 - 10.1159/000515239

DO - 10.1159/000515239

M3 - Journal article

C2 - 33951632

AN - SCOPUS:85105733362

VL - 55

SP - 206

EP - 215

JO - Neuroepidemiology

JF - Neuroepidemiology

SN - 0251-5350

IS - 3

ER -