Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study

Research output: Contribution to journalJournal articleResearchpeer-review

  • Andrew Smyth
  • Conor Judge
  • Xingu Wang
  • Guillaume Pare
  • Sumathy Rangarajan
  • Michelle Canavan
  • Siu Lim Chin
  • Fawaz Al-Hussain
  • Afzalhussein M. Yusufali
  • Ahmed Elsayed
  • Albertino Damasceno
  • Alvaro Avezum
  • Anna Czlonkowska
  • Annika Rosengren
  • Antonio L. Dans
  • Aytekin Oguz
  • Charles Mondo
  • Christian Weimar
  • Danuta Ryglewicz
  • Denis Xavier
  • Fernando Lanas
  • German Malaga
  • Graeme J. Hankey
  • Hongye Zhang
  • Khalid Yusoff
  • Nana Pogosova
  • Patricio Lopez-Jamarillo
  • Peter Langhorne
  • Rafael Diaz
  • Shahram Oveisgharan
  • Salim Yusuf
  • Martin O'Donnell

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.

Original languageEnglish
Issue number3
Pages (from-to)206-215
Number of pages10
Publication statusPublished - 1 Jun 2021

Bibliographical note

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

    Research areas

  • Kidney disease, Stroke

ID: 281225269