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Jaqueto M, Alfieri DF, de Araújo MCM, Fürstenberger Lehmann ALC, Flauzino T, Trevisan ER, Nagao MR, de Freitas LB, Colado Simão AN, Lozovoy MAB, Delfino VDA, Reiche EMV. Acute kidney injury is associated with soluble vascular cell adhesion molecule 1 levels and short-term mortality in patients with ischemic stroke. Clin Neurol Neurosurg 2024; 245:108470. [PMID: 39079288 DOI: 10.1016/j.clineuro.2024.108470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 06/27/2024] [Accepted: 07/26/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The mechanisms that modulate the onset of acute kidney inlury (AKI) after ischemic stroke (IS) and valuable biomarkers to predict the occurrence and prognosis of AKI among patients with IS are missing. OBJECTIVE To evaluate the frequency of AKI and the prognostic validity of clinical and laboratory biomarkers in predicting AKI and short-term mortality after the IS. METHODS Ninety-five patients with IS were enrolled. Baseline IS severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and disability was determined after three-month follow-up using the modified Rankin Scale. Patients with IS were also categorized as survivors and non-survivors after the follow-up. Baseline data and laboratory biomarkers were obtained up to 24 h of the admission. RESULTS Fifteen (15.7 %) patients with IS presented AKI. The proportion of patients with vitamin D deficiency and the mortality were higher among those with AKI than those without AKI (p=0.011 and p-0.009, respectively). Patients with AKI showed higher disability and higher increased soluble vascular cellular adhesion molecule-1 (sVCAM-1) than those without AKI (p=0.029 and p=0.023, respectively). Logistic regression analysis showed that only sVCAM-1 was associated with the occurrence of AKI after IS [odds ratio (OR): 2.715, 95 % confidence intereval (CI): 1.12-6.67, p=0.027]. When both AKI and NIHSS were evaluated as explanatory variables, this panel showed an OR of 5.782 (95 % CI: 1.09-30.43, p<0.001) and correctly classified 83.6 % of cases. CONCLUSION In conclusion, sVCAM-1 levels showed a potential useful for prediction of AKI after IS.
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Affiliation(s)
- Marcel Jaqueto
- Department of Clinical Medicine, Health Science Center and Radiology Service of the University Hospital, State University of Londrina, Paraná, Brazil.
| | - Daniela Frizon Alfieri
- Department of Pharmaceutical Sciences, Health Sciences Center, State University of Londrina, Paraná, Brazil.
| | - Maria Caroline Martins de Araújo
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil.
| | - Ana Lucia Cruz Fürstenberger Lehmann
- Department of Clinical Medicine, Health Science Center and Radiology Service of the University Hospital, State University of Londrina, Paraná, Brazil.
| | - Tamires Flauzino
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil.
| | - Emmanuelle Roberto Trevisan
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil.
| | - Maisa Rocha Nagao
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil.
| | - Leonardo Bodner de Freitas
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil.
| | - Andrea Name Colado Simão
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil; Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Brazil.
| | - Marcell Alysson Batisti Lozovoy
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Paraná, Brazil; School of Medicine of Pontifical Catholic University of Paraná, Campus Londrina, Londrina, Paraná, Brazil; Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Brazil.
| | - Vinicius Daher Alvares Delfino
- Department of Clinical Medicine, Health Science Center and Radiology Service of the University Hospital, State University of Londrina, Paraná, Brazil.
| | - Edna Maria Vissoci Reiche
- Postgraduate Program of Clinical and Laboratory Pathophysiology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Pontificial Catholic University of Paraná, Campus Londrina, School of Medicine, Londrina, Paraná, Brazil.
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Nigussie EW, Abera EG, Woldemariam MB. Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study. Medicine (Baltimore) 2024; 103:e39140. [PMID: 39058854 PMCID: PMC11272293 DOI: 10.1097/md.0000000000039140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.
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Affiliation(s)
| | - Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Jimma University Clinical Trial Unit, Jimma, Oromia, Ethiopia
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Wu MJ, Dewi SRK, Hsu WT, Hsu TY, Liao SF, Chan L, Lin MC. Exploring Relationships of Heart Rate Variability, Neurological Function, and Clinical Factors with Mortality and Behavioral Functional Outcome in Patients with Ischemic Stroke. Diagnostics (Basel) 2024; 14:1304. [PMID: 38928719 PMCID: PMC11202750 DOI: 10.3390/diagnostics14121304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Ischemic stroke is a leading cause of mortality and disability. The relationships of heart rate variability (HRV) and stroke-related factors with mortality and functional outcome are complex and not fully understood. Understanding these relationships is crucial for providing better insights regarding ischemic stroke prognosis. The objective of this study is to examine the relationship between HRV, neurological function, and clinical factors with mortality and 3-month behavioral functional outcome in ischemic stroke. We prospectively collected the HRV data and monitored the behavioral functional outcome of patients with ischemic stroke. The behavioral functional outcome was represented by a modified Rankin Scale (mRS) score. This study population consisted of 58 ischemic stroke patients (56.9% male; mean age 70) with favorable (mRS score ≤ 2) and unfavorable (mRS score ≥ 3) outcome. The analysis indicated that the median of the mean RR interval (RR mean) showed no statistical difference between mortality groups. Conversely, the median of the RR mean had significant association with unfavorable outcome (OR = 0.989, p = 0.007). Lower hemoglobin levels had significant association with unfavorable outcome (OR = 0.411, p = 0.010). Higher National Institute of Health Stroke Scale (NIHSS) score at admission had significant association with unfavorable outcome (OR = 1.396, p = 0.002). In contrast, age, stroke history, NIHSS score at admission, and hemoglobin showed no significant association with mortality in ischemic stroke. These results imply that HRV, as indicated by the median of RR mean, alongside specific clinical factors and neurological function at admission (measured by NIHSS score), may serve as potential prognostic indicators for 3-month behavioral functional outcome in ischemic stroke.
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Affiliation(s)
- Mei-Jung Wu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
- Nursing Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Sari R. K. Dewi
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
| | - Wan-Ting Hsu
- Nursing Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Tien-Yu Hsu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
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Sprick JD, Sabino‐Carvalho J, Mekonnen E, McGranahan M, Zanuzzi M, DaCosta D, Park J. Cerebrovascular carbon dioxide reactivity is intact in chronic kidney disease. Physiol Rep 2024; 12:e15998. [PMID: 38570312 PMCID: PMC10990926 DOI: 10.14814/phy2.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
Chronic kidney disease (CKD) is characterized by an elevated risk for cerebrovascular disease including stroke. One mechanism that may contribute to this heightened risk is an impairment in cerebrovascular carbon dioxide reactivity (CVR). We compared CVR between CKD patients stages III-IV and controls (CON) without CKD but matched for hypertension and diabetes status. CVR was measured via 5% CO2 inhalation followed by voluntary hyperventilation in 14 CKD and 11 CON participants while mean arterial pressure, end-tidal carbon dioxide, and middle cerebral artery blood velocity (MCAv) were measured continuously. CVR was quantified as the linear relationship between etCO2 and MCAv. We observed no difference in CVR between groups. Hypercapnic CVR: CKD = 1.2 ± 0.9 cm/s/mm Hg, CON = 1.3 ± 0.8 cm/s/mm Hg, hypocapnic CVR: CKD = 1.3 ± 0.9 cm/s/mm Hg, CON = 1.5 ± 0.7 cm/s/mm Hg, integrated CVR: CKD = 1.5 ± 1.1 cm/s/mm Hg, CON = 1.7 ± 0.8 cm/s/mm Hg, p ≥ 0.48. Unexpectedly, CVR was inversely related to estimated glomerular filtration rate in CKD (R2 = 0.37, p = 0.02). We report that CVR remains intact in CKD and is inversely related to eGFR. These findings suggest that other mechanisms beyond CVR contribute to the elevated stroke risk observed in CKD.
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Affiliation(s)
- Justin D. Sprick
- Department of Kinesiology, Health Promotion and RecreationUniversity of North TexasDentonTexasUSA
| | - Jeann Sabino‐Carvalho
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Elsa Mekonnen
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Melissa McGranahan
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Matias Zanuzzi
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Dana DaCosta
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Jeanie Park
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
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Ting CW, Lee TH, Huang YH. Admission serum creatinine in non-hemodialysis-dependent patients with spontaneous supratentorial intracerebral hemorrhage: Is it a prognosticator? J Clin Neurosci 2023; 115:84-88. [PMID: 37499324 DOI: 10.1016/j.jocn.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Spontaneous intracerebral hemorrhage (ICH) carries a high mortality rate, with end-stage renal disease (ESRD) and hemodialysis being risk factors for early mortality. However, the role of admission serum creatinine in ICH prognosis remains unclear. This study aimed to analyze the correlation between admission serum creatinine levels and short-term ICH prognosis in non-hemodialysis-dependent patients. METHODS This retrospective study analyzed 296 adult patients admitted with spontaneous supratentorial ICH. Demographic, clinical, and radiographic data were collected, including admission serum creatinine levels. The primary outcomes were mortality and unfavorable outcomes, defined as Modified Rankin Scale scores of 4-6. Univariate or multivariate analysis was performed to examine the association between admission serum creatinine levels and ICH prognosis, with and without the inclusion of maintenance hemodialysis patients. RESULTS Among all patients, elevated admission serum creatinine levels were significantly associated with increased mortality (OR = 1.39, 95% CI: 1.21-1.59, P < 0.01). However, this association disappeared when excluding patients undergoing maintenance hemodialysis (OR = 0.95, 95% CI: 0.53-1.69, P = 0.86). No significant association was found between admission serum creatinine levels and unfavorable outcomes. Other well-established prognostic factors, such as age and admission GCS, demonstrated significant associations with both mortality and unfavorable outcomes in multivariate analysis. CONCLUSION Admission serum creatinine appears to have limited prognostic value in non-hemodialysis-dependent patients with spontaneous supratentorial ICH. Our findings suggest that the relationship between renal function and ICH prognosis is complex and may be influenced by factors such as comorbidities and maintenance hemodialysis.
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Affiliation(s)
- Chun-Wei Ting
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Hua Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Hu C, Li Y, Qian Y, Wu Z, Hu B, Peng Z. Kidney function and cardiovascular diseases: a large-scale observational and Mendelian randomization study. Front Immunol 2023; 14:1190938. [PMID: 37529046 PMCID: PMC10390297 DOI: 10.3389/fimmu.2023.1190938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Prior observational studies have found an association between kidney function and cardiovascular diseases (CVDs). However, these studies did not investigate causality. Therefore, the aim of this study is to examine the causal relationship between kidney function and CVDs. Methods We utilized data from the eICU Collaborative Research Database (eICU-CRD) from the years 2014-2015 to evaluate the observational association between renal failure (RF) and CVDs. To investigate the causal effects of kidney function (estimated glomerular filtration rate [eGFR] and chronic kidney disease [CKD]) and CVDs (including atrial fibrillation [AF], coronary artery disease [CAD], heart failure [HF], any stroke [AS], and any ischemic stroke [AIS]), we conducted a two-sample bidirectional Mendelian randomization (MR) analysis. Results In the observational analysis, a total of 157,883 patients were included. After adjusting for potential confounding factors, there was no significant association between baseline RF and an increased risk of developing CVDs during hospitalization [adjusted odds ratio (OR): 1.056, 95% confidence interval (CI): 0.993 to 1.123, P = 0.083]. Conversely, baseline CVDs was significantly associated with an increased risk of developing RF during hospitalization (adjusted OR: 1.189, 95% CI: 1.139 to 1.240, P < 0.001). In the MR analysis, genetically predicted AF was associated with an increased risk of CKD (OR: 1.050, 95% CI: 1.016 to 1.085, P = 0.004). HF was correlated with lower eGFR (β: -0.056, 95% CI: -0.090 to -0.022, P = 0.001). A genetic susceptibility for AS and AIS was linked to lower eGFR (β: -0.057, 95% CI: -0.079 to -0.036, P < 0.001; β: -0.029, 95% CI: -0.050 to -0.009, P = 0.005; respectively) and a higher risk of CKD (OR: 1.332, 95% CI: 1.162 to 1.528, P < 0.001; OR: 1.197, 95% CI: 1.023 to 1.400, P = 0.025; respectively). Regarding the reverse direction analysis, there was insufficient evidence to prove the causal effects of kidney function on CVDs. Outcomes remained consistent in sensitivity analyses. Conclusion Our study provides evidence for causal effects of CVDs on kidney function. However, the evidence to support the causal effects of kidney function on CVDs is currently insufficient. Further mechanistic studies are required to determine the causality.
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Affiliation(s)
- Chang Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yiming Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yaoyao Qian
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhenying Wu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Critical Care Medicine, Center of Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Kumar M, Kumar A, Saroj U, Kumar R, Singh SK, Choudhary AK, Farheen Z, Priya S. A Study on the Clinical Profiles of Patients With Cerebrovascular Accident (Stroke) in a Tertiary Care Hospital in Jharkhand. Cureus 2023; 15:e35919. [PMID: 37050994 PMCID: PMC10085251 DOI: 10.7759/cureus.35919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction Stroke is a devastating and disabling cerebrovascular disease with a significant amount of residual deficit. The prevalence of stroke is in a rising trend in India. Larger studies are needed for the evaluation of risk factors. Material and methods This cross-sectional study aimed to assess the clinical profile of patients with stroke. The demographic details of the patients were taken, comorbidities were noted, and laboratory tests were done. Observation The most common age group who presented with stroke was 61-80 years, followed by 41-60 years, comprising 47% and 46%, respectively. Ischemic stroke was more common (60%) than hemorrhagic stroke (40%). Male patients were more than female patients. Alcohol, smoking, hypertension, diabetes, anemia, and proteinuria were present in the study group. Conclusion Regular evaluation of blood pressure, blood sugar, lipid profile, and proteinuria should be routinely done in patients with diabetes and hypertension who are more than 40 years old.
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Wang IK, Yen TH, Tsai CH, Sun Y, Chang WL, Chen PL, Lai TC, Yeh PY, Wei CY, Lin CL, Hsu KC, Li CY, Sung FC, Hsu CY. Renal function is associated with one-month and one-year mortality in patients with intracerebral hemorrhage. PLoS One 2023; 18:e0269096. [PMID: 36701340 PMCID: PMC9879419 DOI: 10.1371/journal.pone.0269096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/15/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with the glomerular filtration rate (eGFR) on admission for patients with intracerebral hemorrhage. METHODS From the Taiwan Stroke Registry data from April 2006 to December 2016, we identified and stratified patients with intracerebral hemorrhage into five subgroups by the eGFR level on admission: ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m2 or on dialysis. Risks for 1-month and 1-year mortality after intracerebral hemorrhage were compared by the eGFR levels. RESULTS Both the 1-month and 1-year mortality rates progressively increased with the decrease in eGFR levels. The 1-month mortality rate in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was approximately 5.5-fold greater than that in patients with eGFR ≥ 90 mL/min/1.73 m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 [95% confidence interval (CI) = 2.71-7.78]. Similarly, the 1-year mortality in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was 7.5 times that in patients with eGFR ≥ 90 mL/min/1.73 m2 (2.34 versus 0.31 per 1000 person-days), with an adjusted HR of 4.54 (95% CI 2.95-6.98). CONCLUSION Impairment of renal function is an independent risk factor for mortality in patients with intracerebral hemorrhage in a gradual way. The eGFR level is a prognostic indicator for patients with intracerebral hemorrhage.
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Affiliation(s)
- I-Kuan Wang
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chon-Haw Tsai
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Yu Sun
- Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chang Lai
- Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
- * E-mail:
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Science, China Medical University College of Medicine, Taichung, Taiwan
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Sprick JD, Jones T, Jeong J, DaCosta D, Park J. Dynamic cerebral autoregulation is intact in chronic kidney disease. Physiol Rep 2022; 10:e15495. [PMID: 36325592 PMCID: PMC9630754 DOI: 10.14814/phy2.15495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 05/09/2023] Open
Abstract
Chronic Kidney Disease (CKD) patients experience an elevated risk for cerebrovascular disease. One factor that may contribute to this heightened risk is an impairment in dynamic cerebral autoregulation, the mechanism by which cerebral vessels modulate cerebral blood flow during fluctuations in arterial pressure. We hypothesized that dynamic cerebral autoregulation would be impaired in CKD. To test this hypothesis, we compared dynamic cerebral autoregulation between CKD patients stages III-IV and matched controls (CON) without CKD. Fifteen patients with CKD and 20 CON participants performed 2, 5-minute bouts of repeated sit-to-stand maneuvers at 0.05 Hz and 0.10 Hz while mean arterial pressure (MAP, via finger photoplethysmography) and middle cerebral artery blood velocity (MCAv, via transcranial Doppler ultrasound) were measured continuously. Cerebral autoregulation was characterized by performing a transfer function analysis (TFA) on the MAP-MCAv relationship to derive coherence, phase, gain, and normalized gain (nGain). We observed no group differences in any of the TFA metrics during the repeated sit-to-stand maneuvers. During the 0.05 Hz maneuver, Coherence: CKD = 0.83 ± 0.13, CON = 0.85 ± 0.12, Phase (radians): CKD = 1.39 ± 0.41, CON = 1.25 ± 0.30, Gain (cm/s/mmHg): CKD = 0.69 ± 0.20, CON = 0.71 ± 0.22, nGain (%/mmHg): CKD = 1.26 ± 0.35, CON = 1.20 ± 0.28, p ≥ 0.24. During the 0.10 Hz maneuver (N = 6 CKD and N = 12 CON), Coherence: CKD = 0.61 ± 0.10, CON = 0.67 ± 0.11, Phase (radians): CKD = 1.43 ± 0.26, CON = 1.30 ± 0.23, Gain (cm/s/mmHg): CKD = 0.75 ± 0.15, CON = 0.84 ± 0.26, nGain (%/mmHg): CKD = 1.50 ± 0.28, CON = 1.29 ± 0.24, p ≥ 0.12. Contrary to our hypothesis, dynamic cerebral autoregulation remains intact in CKD stages III-IV. These findings suggest that other mechanisms likely contribute to the increased cerebrovascular disease burden experienced by this population. Future work should determine if other cerebrovascular regulatory mechanisms are impaired and related to cerebrovascular disease risk in CKD.
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Affiliation(s)
- Justin D. Sprick
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Veterans Affairs Health Care SystemDecaturGeorgiaUSA
- Department of Kinesiology, Health Promotion and RecreationUniversity of North TexasDentonTexasUSA
| | - Toure Jones
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Veterans Affairs Health Care SystemDecaturGeorgiaUSA
| | - Jinhee Jeong
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Veterans Affairs Health Care SystemDecaturGeorgiaUSA
| | - Dana DaCosta
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Veterans Affairs Health Care SystemDecaturGeorgiaUSA
| | - Jeanie Park
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Veterans Affairs Health Care SystemDecaturGeorgiaUSA
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10
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Xin W, Qin Y, Lei P, Zhang J, Yang X, Wang Z. From cerebral ischemia towards myocardial, renal, and hepatic ischemia: Exosomal miRNAs as a general concept of intercellular communication in ischemia-reperfusion injury. MOLECULAR THERAPY - NUCLEIC ACIDS 2022; 29:900-922. [PMID: 36159596 PMCID: PMC9464648 DOI: 10.1016/j.omtn.2022.08.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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The Role of the Monocyte-to-Lymphocyte Ratio in Acute Ischemic Stroke Patients with Acute Kidney Injury. Mediators Inflamm 2022; 2022:7911033. [PMID: 36072574 PMCID: PMC9441381 DOI: 10.1155/2022/7911033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The objective of the study was to determine if acute kidney injury (AKI) in patients with acute ischemic stroke was associated with the monocyte-to-lymphocyte ratio (MLR) assessed upon admission to the neurology intensive care unit (NICU) (AIS). We also looked into the MLR's function in predicting hospital mortality in AIS patients. Methods This retrospective analysis included 595 adult patients with AIS who were hospitalized to the NICU of the First Affiliated Hospital of South China between January 2017 and December 2019. Clinical signs and imaging studies were used to diagnose AIS. KDIGO criteria were used to define AKI. The ratio of monocytes to lymphocytes was used to compute MLR, the ratio of neutrophils to lymphocytes was used to calculate NLR, and the ratio of platelets to lymphocytes was used to calculate PLR. Result 361 males and 234 women between the ages of 66.27 ± 12.05 years took part in the study. The individuals' MLR was 0.4729 ± 0.3461 and their neutrophil-to-lymphocyte ratio (NLR) was 8.18 ± 5.45. There were notable disparities in MLR and NLR between the AKI and non-AKI groups (p < 0.001). The link between MLR and AKI development risk was enhanced after adjustment, with respective cutoff values of 0.4581 and 9.26. For the MLR-based prediction of AKI incidence, the areas under the receiver-operating characteristic curves (AUCs) were 0.711 (95% CI: 0.663-0.758). And NLR-based prediction of AKI incidence the AUCs was (95% CI: 0.742-0826). Additionally, MLR was associated with a higher rate of in-hospital mortality (2.825, 95% confidence interval: 1.058, 7.545), whereas NLR was associated with a risk of in-hospital mortality of 1.085. (95 percent CI: 1.022, 1.151). An AUC of 0.745 (95% CI: 0.601-0.889, p = 0.026) was obtained for in-hospital mortality based on the MLR, whereas an AUC of 0.724 (95% CI: 0.531-0.916, p = 0.042) was obtained for in-hospital mortality based on the NLR. Conclusion MLR and neutrophil-to-lymphocyte ratio (NLR) were associated with a higher risk of AKI and in-hospital death in AIS patients.
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12
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Shen HS, Hsu CY, Yip HT, Lin IH. Lower risk of ischemic stroke among patients with chronic kidney disease using chinese herbal medicine as add-on therapy: A real-world nationwide cohort study. Front Pharmacol 2022; 13:883148. [PMID: 36034816 PMCID: PMC9403506 DOI: 10.3389/fphar.2022.883148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The incidence of ischemic stroke (IS) is much higher among patients with chronic kidney disease (CKD) compared to the general population. Few studies have evaluated the association between the risk of IS and the use of Chinese herbal medicine (CHM) in patients with CKD. We aimed to investigate the risk of IS among patients with CKD using CHM as add-on therapy.Methods: We conducted a retrospective cohort study based on Taiwan’s National Health Insurance Research Database to assess 21,641 patients with newly diagnosed CKD between 2003 and 2012. Patients were classified as either the CHM (n = 3,149) or the non-CHM group (n = 3,149) based on whether they used CHM after first diagnosis of CKD. We used the proportional subdistribution hazards model of Fine and Gray to examine the hazard ratio (HR) of IS in propensity-score matched samples at a ratio of 1:1 for two groups.Results: The risk of IS was significantly reduced in the CHM group (adjusted HR [aHR]: 0.58, 95% confidence interval [CI]: 0.48–0.70) compared with the non-CHM group. Those who used CHM for >180 days had an even lower risk of IS than those in the non-CHM group (aHR: 0.51, 95% CI: 0.41–0.63). Additionally, frequently prescribed formulae, such as Ji-Sheng-Shen-Qi-Wan, Liu-Wei-Di-Huang-Wan, and Zhen-Wu-Tang were associated with a 30%–50% reduced risk of IS.Conclusion: Our results suggest that patients with CKD who used CHM as add-on therapy had a lower hazard of IS than those in the non-CHM group, especially for patients taking CHM for >180 days. Further experimental studies are required to clarify the causal relationship.
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Affiliation(s)
- Hsuan-Shu Shen
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- Sports Medicine Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Chung-Yi Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Hsin Lin
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- *Correspondence: I-Hsin Lin,
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13
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Jiang F, Liu J, Yu X, Li R, Zhou R, Ren J, Liu X, Zhao S, Yang B. The Monocyte-to-Lymphocyte Ratio Predicts Acute Kidney Injury After Acute Hemorrhagic Stroke. Front Neurol 2022; 13:904249. [PMID: 35795792 PMCID: PMC9251466 DOI: 10.3389/fneur.2022.904249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Acute kidney injury (AKI) is a serious complication of acute hemorrhagic stroke (AHS). Early detection and early treatment are crucial for patients with AKI. We conducted a study to analyze the role of the monocyte-to-lymphocyte ratio (MLR) in predicting the development of AKI after AHS. Methods This retrospective observational study enrolled all subjects with AHS who attended the neurosurgical intensive care unit (NSICU) at the First Affiliated University of South China between 2018 and 2021. Patient demographics, laboratory data, treatment details, and clinical outcomes were recorded. Results Of the 771 enrolled patients, 180 (23.3%) patients developed AKI. Compared to patients without AKI, those with AKI had a higher MLR and the neutrophil-lymphocyte ratio (NLR) at admission (P < 0.001). The MLR and the NLR at admission were associated with an increased AKI risk, with odds ratios (ORs) of 8.27 (95% CI: 4.23, 16.17, p < 0.001) and 1.17 (95% CI: 1.12, 1.22, p < 0.001), respectively. The receiver operating characteristic curve (ROC) analysis was conducted to analyze the ability of the MLR and NLR to predict AKI, and the areas under the curve (AUCs) of the MLR and the NLR were 0.73 (95% CI: 0.69, 0.77, p < 0.001) and 0.67 (95% CI: 0.62, 0.72, p < 0.001), with optimal cutoff values of 0.5556 and 11.65, respectively. The MLR and the NLR at admission were associated with an increased in-hospital mortality risk, with ORs of 3.13 (95% CI: 1.08, 9.04) and 1.07 (95% CI: 1.00, 1.14), respectively. The AUCs of the MLR and the NLR for predicting in-hospital mortality were 0.62 (95% CI: 0.54, 0.71, p = 0.004) and 0.52 (95% CI: 0.43, 0.62, p = 0.568), respectively. The optimal cutoff value for the MLR was 0.7059, with a sensitivity of 51% and a specificity of 73.3%. Conclusions MLR and NLR measurements in patients with AHS at admission could be valuable tools for identifying patients at high risk of early AKI. The MLR was positively associated with in-hospital mortality and the NLR showed a weak ability for the prediction of in-hospital mortality.
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Affiliation(s)
- Fen Jiang
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jialing Liu
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xin Yu
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Rui Li
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Run Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jianke Ren
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiangyang Liu
- Department of Clinical Medicine, Xiangnan University, Chenzhou, China
| | - Saili Zhao
- Department of Nursing, Hengyang Medical School, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Bo Yang
- Department of Nephrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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14
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Zhou Y, Wang D, Li H, Pan Y, Xiang X, Wu Y, Xie X, Wang X, Luo Y, Meng X, Lin J, Wang H, Huo Y, Matsushita K, Chen J, Hou FF, Wang Y. Association of acute kidney disease with the prognosis of ischemic stroke in the Third China National Stroke Registry. BMC Nephrol 2022; 23:188. [PMID: 35585568 PMCID: PMC9115968 DOI: 10.1186/s12882-022-02817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Acute kidney disease (AKD) evolves a spectrum of acute and subacute kidney disease requiring a global strategy to address. The present study aimed to explore the impact of AKD on the prognosis of ischemic stroke. Methods The Third China National Stroke Registry (CNSR-III) was a nationwide registry of ischemic stroke or transient ischemic attack between August 2015 and March 2018. As a subgroup of CNSR-III, the patients who had serum creatinine (sCr) and serum cystatin C (sCysC) centrally tested on admission and at 3-month, and with 1-year follow-up data were enrolled. Modified AKD criteria were applied to identify patients with AKD during the first 3 months post stroke according to the guidelines developed by the Kidney Disease: Improving Global Outcomes in 2012. The primary clinical outcome was 1-year all-cause death, and secondary outcomes were stroke recurrence and post stroke disability. Results Five thousand sixty-five patients were recruited in the study. AKD was identified in 3.9%, 6.7%, 9.9% and 6.2% of the patients by using sCr, sCr-based estimated glomerular filtration rate (eGFRsCr), sCysC-based eGFR (eGFRsCysC), and combined sCr and sCysC-based eGFR (eGFRsCr+sCysC) criteria, respectively. AKD defined as sCr or eGFRsCr criteria significantly increased the risk of all-cause mortality (adjusted HR 2.67, 95% CI: 1.27–5.61; adjusted HR 2.19, 95% CI: 1.17–4.10) and post stroke disability (adjusted OR 1.60, 95% CI: 1.04–2.44; adjusted OR 1.51, 95% CI: 1.08–2.11). AKD diagnosed by eGFRsCysC or eGFRsCr+sCysC criteria had no significant impact on the risk of all-cause death and post stroke disability. AKD, defined by whichever criteria, was not associated with the risk of stroke recurrence in the adjusted model. Conclusions AKD, diagnosed by sCr or eGFRsCr criteria, were independently associated with 1-year all-cause death and post stroke disability in Chinese ischemic stroke patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02817-4.
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Affiliation(s)
- Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dongxue Wang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xianglong Xiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu Wu
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuewei Xie
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xianwei Wang
- Center for Metabolic Disease Research, Lewis Kats School of Medicine, Temple University, Philadelphia, USA
| | - Yang Luo
- Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jinxi Lin
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hong Wang
- Center for Metabolic Disease Research, Lewis Kats School of Medicine, Temple University, Philadelphia, USA
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | | | - Jing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.,Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China. .,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China. .,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China. .,Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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15
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Tung IM, Barlas RS, Vart P, Bettencourt-Silva JH, Clark AB, Sawanyawisuth K, Kongbunkiat K, Kasemsap N, Tiamkao S, Myint PK. Association of chronic kidney disease with outcomes in acute stroke. Acta Neurol Belg 2021; 121:1241-1246. [PMID: 32661738 PMCID: PMC8443515 DOI: 10.1007/s13760-020-01416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022]
Abstract
Previous studies have found an association between chronic kidney disease and poor outcomes in stroke patients. However, there is a paucity of literature evaluating this association by stroke type. We therefore aimed to explore the association between CKD and stroke outcomes according to type of stroke. The data consisting of 594,681 stroke patients were acquired from Universal Coverage Health Security Insurance Scheme Database in Thailand. Binary logistic regression was used to assess the relationship of CKD and outcomes, which were as follows; in-hospital mortality, long length of stay (>3 days), pneumonia, sepsis, respiratory failure and myocardial infarction. Results: after fully adjusting for covariates, CKD was associated with increased odds of in-hospital mortality in patients with ischemic (OR 1.32; 95% CI = 1.27–1.38), haemorrhagic (OR 1.31; 95% CI = 1.24–1.39), and other undetermined stroke type (OR 1.44; 95% CI = 1.21–1.73). CKD was found to be associated with increased odds of pneumonia, sepsis, respiratory failure and myocardial infarction in ischaemic stroke. While CKD was found to be associated with increase odds of sepsis, respiratory failure, and myocardial infarction, decrease odds of pneumonia was observed in patients with haemorrhagic stroke. In other undetermined stroke type, CKD was found to only be associated with increase odds of sepsis and respiratory failure, while there is no significant association of CKD and increase or decrease odds with pneumonia and myocardial infarction. CKD was associated with poor outcomes in all stroke types. CKD should be considered as part of stroke prognosis as well as identifying at risk patient population for in-hospital complications.
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16
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Cui P, McCullough LD, Hao J. Brain to periphery in acute ischemic stroke: Mechanisms and clinical significance. Front Neuroendocrinol 2021; 63:100932. [PMID: 34273406 PMCID: PMC9850260 DOI: 10.1016/j.yfrne.2021.100932] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023]
Abstract
The social and public health burdens of ischemic stroke have been increasing worldwide. In addition to focal brain damage, acute ischemic stroke (AIS) provokes systemic abnormalities across peripheral organs. AIS profoundly alters the autonomic nervous system, hypothalamic-pituitary-adrenal axis, and immune system, which further yield deleterious organ-specific consequences. Poststroke systemic pathological alterations in turn considerably contribute to the progression of ischemic brain injury, which accounts for the substantial impact of systemic complications on stroke outcomes. This review provides a comprehensive and updated pathophysiological model elucidating the systemic effects of AIS. To address their clinical significance and inform stroke management, we also outline the resulting systemic complications at particular stages of AIS and highlight the mechanisms. Future therapeutic strategies should attempt to integrate the treatment of primary brain lesions with interventions for secondary systemic complications, and should be tailored to patient individualized characteristics to optimize stroke outcomes.
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Affiliation(s)
- Pan Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Science Centre, Houston, TX 77030, USA
| | - Junwei Hao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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17
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Ramírez-Guerrero G, Baghetti-Hernández R, Ronco C. Acute Kidney Injury at the Neurocritical Care Unit. Neurocrit Care 2021; 36:640-649. [PMID: 34518967 DOI: 10.1007/s12028-021-01345-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Abstract
Neurocritical care has advanced substantially in recent decades, allowing doctors to treat patients with more complicated conditions who require a multidisciplinary approach to achieve better clinical outcomes. In neurocritical patients, nonneurological complications such as acute kidney injury (AKI) are independent predictors of worse clinical outcomes. Different research groups have reported an AKI incidence of 11.6% and an incidence of stage 3 AKI, according to the Kidney Disease: Improving Global Outcomes, that requires dialysis of 3% to 12% in neurocritical patients. These patients tend to be younger, have less comorbidity, and have a different risk profile, given the diagnostic and therapeutic procedures they undergo. Trauma-induced AKI, sepsis, sympathetic overstimulation, tubular epitheliopathy, hyperchloremia, use of nephrotoxic drugs, and renal hypoperfusion are some of the causes of AKI in neurocritical patients. AKI is the result of a sum of events, although the mechanisms underlying many of them remain uncertain; however, two important causes that merit mention are direct alteration of the physiological brain-kidney connection and exposure to injury as a result of the specific medical management and well-established therapies that neurocritical patients are subjected to. This review will focus on AKI in neurocritical care patients. Specifically, it will discuss its epidemiology, causes, associated mechanisms, and relationship to the brain-kidney axis. Additionally, the use and risks of extracorporeal therapies in this group of patients will be reviewed.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile.
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile.
- Deparment of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
| | - Romyna Baghetti-Hernández
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Deparment of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Claudio Ronco
- Department of Medicine, Università di Padova, Padua, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza, Vicenza, Italy
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18
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Chabala FW, Siew ED, Mutale W, Mulenga L, Mweemba A, Goma F, Banda N, Kaonga P, Wester WC, Heimburger DC, Aliyu MH, Munkombwe D. Prognostic model for nephrotoxicity among HIV-positive Zambian adults receiving tenofovir disoproxil fumarate-based antiretroviral therapy. PLoS One 2021; 16:e0252768. [PMID: 34252117 PMCID: PMC8274919 DOI: 10.1371/journal.pone.0252768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/22/2021] [Indexed: 11/19/2022] Open
Abstract
Persons living with HIV (PLWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) risk suffering TDF-associated nephrotoxicity (TDFAN). TDFAN can result in short- and long-term morbidity, including permanent loss of kidney function, chronic kidney disease (CKD), and end-stage kidney disease (ESKD) requiring dialysis. Currently, there is no model to predict this risk or discern which patients to initiate TDF-based therapy. Consequently, some patients suffer TDFAN within the first few months of initiating therapy before switching to another suitable antiretroviral or a lower dose of TDF. In a prospective observational cohort study of adult Zambian PLWH, we modelled the risk for TDFAN before initiating therapy to identify individuals at high risk for experiencing AKI after initiating TDF-based therapy. We enrolled 205 HIV-positive, ART-naïve adults initiating TDF-based therapy followed for a median of 3.4 months for TDFAN at the Adult Infectious Disease Research Centre (AIDC) in Lusaka, Zambia. We defined TDFAN as meeting any of these acute kidney disease (AKD) criteria: 1) An episode of estimated glomerular filtration rate (eGFR)< 60ml/ min/1.73m2 within 3 months, 2) reduced eGFR by> 35% within 3 months or 3) increased serum creatinine by> 50% within 3 months. A total of 45 participants (22%) developed acute kidney disease (AKD) after TDF-based therapy. The development of AKD within the first 3 months of commencing TDF-based therapy was associated with an increase in baseline serum creatinine, age, baseline eGFR and female sex. We concluded that baseline characteristics and baseline renal function biomarkers predicted the risk for AKD within the first 3-months of TDF-based therapy.
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Affiliation(s)
- Freeman W. Chabala
- Levy Mwanawasa Medical University, Institute of Basic and Biomedical Sciences, Lusaka, Zambia
- The University of Zambia, School of Medicine, Lusaka, Zambia
| | - Edward D. Siew
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Tennessee Valley Health Systems (TVHS), Veterans Affairs, Nashville, TN, United States of America
| | - Wilbroad Mutale
- The University of Zambia, School of Public Health, Lusaka, Zambia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Lloyd Mulenga
- The University of Zambia, School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Aggrey Mweemba
- The University of Zambia, School of Medicine, Lusaka, Zambia
- The University Teaching Hospital, Lusaka, Zambia
| | - Fastone Goma
- The University of Zambia, School of Medicine, Lusaka, Zambia
| | | | - Patrick Kaonga
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - William C. Wester
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- The University Teaching Hospital, Lusaka, Zambia
| | - Douglas C. Heimburger
- The University of Zambia, School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Muktar H. Aliyu
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Meharry Medical College School of Medicine, Nashville, TN, United States of America
| | - Derick Munkombwe
- The University of Zambia, School of Health Sciences, Lusaka, Zambia
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19
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Wells MA, Morbitzer K, Rhoney DH. Evaluation of the Accuracy of Standard Renal Function Equations in Critically Ill Patients with Subarachnoid Hemorrhage. Neurocrit Care 2021; 32:828-835. [PMID: 31591691 DOI: 10.1007/s12028-019-00854-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obtaining an accurate estimation of renal function is germane to optimizing care in critically ill patients. However, there is no consensus on the most accurate renal function assessment to utilize in this patient population, particularly in aneurysmal subarachnoid hemorrhage (aSAH) patients. Thus, the objective of this observational study was to determine the comparability of renal function equations to body surface area (BSA)-adjusted 8-h creatinine clearance (CrCl) in aSAH patients. METHODS A PubMed search investigated the applicability of various renal function equations in critically ill patient populations. A subset of these equations was compared to BSA-adjusted 8-h CrCl from a previous study with aSAH patients with no evidence of renal dysfunction (admission serum creatinine < 1.5 mg/dL) and no history of chronic kidney disease. Area-under-the-curve (AUC) calculations were completed using serial laboratory measurements to validate preliminary findings. RESULTS A total of 14 renal function equations were identified with seven carried forward for further analysis based upon a priori criteria. Seven equations were excluded for various reasons, including lack of available clinical data, redundancy with other equations, and dissimilar patient populations to this study. When directly compared to the BSA-adjusted 8-h CrCl, only the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault equations were not statistically significantly different (P = 0.0886 and P = 0.4805, respectively); all other equations were statistically significantly different (P < 0.0001). Additionally, only 52% and 44% of patients had average values within 20% of the BSA-adjusted 8-h CrCl using the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault equations, respectively. Finally, the AUC calculations corroborated the preliminary findings with similar results in statistical testing for the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault (P = 0.6300 and P = 0.1513, respectively). CONCLUSIONS The Cockcroft-Gault equation may be the best renal function equation to assess in critically ill patients diagnosed with aSAH. However, accuracy and consistency in assessing renal function when compared to the BSA-adjusted 8-h CrCl were lacking. Thus, this study suggests the BSA-adjusted 8-h CrCl may be the most appropriate assessment of renal function in patients with aSAH.
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Affiliation(s)
- Michael A Wells
- Division of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Kathryn Morbitzer
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, 115E Beard Hall, Campus, Box 7574, Chapel Hill, NC, 27599-7574, USA
| | - Denise H Rhoney
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, 115E Beard Hall, Campus, Box 7574, Chapel Hill, NC, 27599-7574, USA.
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20
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Smyth A, Judge C, Wang X, Pare G, Rangarajan S, Canavan M, Chin SL, Al-Hussain F, Yusufali AM, Elsayed A, Damasceno A, Avezum A, Czlonkowska A, Rosengren A, Dans AL, Oguz A, Mondo C, Weimar C, Ryglewicz D, Xavier D, Lanas F, Malaga G, Hankey GJ, Iversen HK, Zhang H, Yusoff K, Pogosova N, Lopez-Jamarillo P, Langhorne P, Diaz R, Oveisgharan S, Yusuf S, O'Donnell M. Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study. Neuroepidemiology 2021; 55:206-215. [PMID: 33951632 DOI: 10.1159/000515239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Andrew Smyth
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.,HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland.,Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - Conor Judge
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.,HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland.,Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - Xingu Wang
- Beijing Hypertension League Institute, Beijing, China
| | - Guillaume Pare
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michelle Canavan
- HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland
| | - Siu Lim Chin
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | - Annika Rosengren
- Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Antonio L Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Charles Mondo
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | | | - Denis Xavier
- St John's Medical College and Research Institute, Bangalore, India
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Washington, Australia
| | - Helle K Iversen
- Stroke Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hongye Zhang
- Beijing Hypertension League Institute, Beijing, China
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang, Selangor, Malaysia, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - Patricio Lopez-Jamarillo
- Instituto de Investigaciones FOSCAL, Escuela de Medicina, Universidad de Santander, Bucaramanga, Colombia
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Martin O'Donnell
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.,HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland
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21
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Wyld M, Webster AC. Chronic Kidney Disease is a Risk Factor for Stroke. J Stroke Cerebrovasc Dis 2021; 30:105730. [PMID: 33926795 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105730] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
Chronic kidney disease (CKD) is a sustained reduction in estimated glomerular filtration rate (eGFR), and/or presence of albuminuria. People with CKD have adverse cardiovascular outcomes including stroke. CKD and stroke share several risk factors, most notably older age, diabetes and hypertension, but CKD is also an independent risk factor for stroke. Relative burden of increased risk is worse for younger people and women, with <40 years with end stage CKD having more than 11 times the risk of their age-matched peers. Risk also varies by CKD treatment, with a risk peak for those starting dialysis, but dropping after the first month of treatment. Proposed mechanisms for increased risk are uraemia, cerebral blood flow dysregulation, vascular calcification, arterial stiffness, chronic inflammation, vascular access impacts, and for those on haemodialysis the use of anticoagulation to maintain dialysis circuits. Outcomes for people with CKD and stroke are poorer; functional outcomes may be impacted by reduced access to specialised stroke care. Stroke mortality is higher for those with CKD; with standardised mortality ratio more than three times higher than expected, but for some groups higher still (young women <40 years with a kidney transplant have 19 times the risk of stroke mortality than women without a transplant). Interventions to prevent and treat stroke lack the evidence base in CKD patients that is present for the general population.
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Affiliation(s)
- Melanie Wyld
- Centre of Transplant and Renal Research, Westmead Hospital, Westmead, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Angela C Webster
- Centre of Transplant and Renal Research, Westmead Hospital, Westmead, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 129a Edward Ford Building A27, NSW 2006, Australia; NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia.
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22
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Lee JS, Hwang YH, Sohn SI. Factors Contributing to an Efficacious Endovascular Treatment for Acute Ischemic Stroke in Asian Population. Neurointervention 2021; 16:91-110. [PMID: 33765729 PMCID: PMC8261106 DOI: 10.5469/neuroint.2020.00339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Although randomized control trials about endovascular treatment (EVT) of emergent large vessel occlusion (LVO) have demonstrated the success of mechanical thrombectomy as the choice of treatment, a wide range of caveats remain unaddressed. Asian patients were rarely included in the trials, thereby raising the question of whether the treatment could be generalized. In addition, there remains a concern on the feasibility of the method with respect to its application against intracranial atherosclerosis (ICAS)-related LVO, frequently observed in the Asian population. It is important to include evidence on ICAS LVO from Asian countries in the future for a comprehensive understanding of LVO etiology. Besides the issues with EVT, prognostic concerns in diabetes patients, acute kidney injury following EVT, neuroprotective management against reperfusion injury, and other peri-EVT issues should be considered in clinical practice. In the current article, we present an in-depth review of the literature that revises information pertaining to such concerns.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Kyemyung University School of Medicine, Daegu, Korea
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23
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Chao CH, Wu CL, Huang WY. Association between estimated glomerular filtration rate and clinical outcomes in ischemic stroke patients with high-grade carotid artery stenosis. BMC Neurol 2021; 21:124. [PMID: 33740899 PMCID: PMC7977561 DOI: 10.1186/s12883-021-02154-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/10/2021] [Indexed: 01/21/2023] Open
Abstract
Background Chronic kidney disease has been identified as a risk factor affecting stroke prognosis. High-grade carotid artery stenosis (CAS) is associated with distal hemodynamic compromise. The association between the estimated glomerular filtration rate (eGFR) and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between eGFR and outcomes of acute IS patients with high-grade CAS. Methods From January 1, 2007 to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. The eGFR on admission was assessed using the Modification of Diet in Renal Disease Study equation. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between different eGFR levels. Results Among 372 individuals, 76 (20.4%) had an eGFR < 45, 65 (17.5%) had an eGFR between 45 and 59, and 231 (62.1%) had an eGFR ≥60 mL/min/1.73 m2. Compared to other groups, in the eGFR < 45 mL/min/1.73 m2 group, the prevalence rates of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, valvular heart disease, and gout were significantly higher (P = 0.013, P = 0.030, P = 0.001, P < 0.001, P = 0.043, and P < 0.001, respectively). Patients with eGFR < 45 mL/min/1.73 m2 demonstrated lower hemoglobin and total cholesterol levels compared with other groups (P < 0.001 and P = 0.048). The blood potassium and uric acid levels were significantly higher in patients with eGFR < 45 mL/min/1.73 m2 (P < 0.001 and P < 0.001). The multivariate Cox proportional hazards model indicated that eGFR < 45 mL/min/1.73 m2 was a significant risk factor for 5-year all-cause mortality in IS patients with high-grade CAS after adjusting for these variables (hazard ratio = 2.05; 95% CI = 1.31–3.21; P = 0.002). Conclusions eGFR < 45 mL/min/1.73 m2 was associated with an increased risk of 5-year all-cause mortality in acute IS patients with high-grade CAS. Whether aggressive treatment of chronic kidney disease in IS patients with high-grade CAS can improve stroke outcomes should be confirmed in future studies.
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Affiliation(s)
- Chung-Hao Chao
- Department of Neurology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Keelung branch, No.222, Mai-Jin Road, Keelung, 204, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Keelung branch, No.222, Mai-Jin Road, Keelung, 204, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Keelung branch, No.222, Mai-Jin Road, Keelung, 204, Taiwan.
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24
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Deferrari G, Cipriani A, La Porta E. Renal dysfunction in cardiovascular diseases and its consequences. J Nephrol 2021; 34:137-153. [PMID: 32870495 PMCID: PMC7881972 DOI: 10.1007/s40620-020-00842-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
It is well known that the heart and kidney and their synergy is essential for hemodynamic homeostasis. Since the early XIX century it has been recognized that cardiovascular and renal diseases frequently coexist. In the nephrological field, while it is well accepted that renal diseases favor the occurrence of cardiovascular diseases, it is not always realized that cardiovascular diseases induce or aggravate renal dysfunctions, in this way further deteriorating cardiac function and creating a vicious circle. In the same clinical field, the role of venous congestion in the pathogenesis of renal dysfunction is at times overlooked. This review carefully quantifies the prevalence of chronic and acute kidney abnormalities in cardiovascular diseases, mainly heart failure, regardless of ejection fraction, and the consequences of renal abnormalities on both organs, making cardiovascular diseases a major risk factor for kidney diseases. In addition, with regard to pathophysiological aspects, we attempt to substantiate the major role of fluid overload and venous congestion, including renal venous hypertension, in the pathogenesis of acute and chronic renal dysfunction occurring in heart failure. Furthermore, we describe therapeutic principles to counteract the major pathophysiological abnormalities in heart failure complicated by renal dysfunction. Finally, we underline that the mild transient worsening of renal function after decongestive therapy is not usually associated with adverse prognosis. Accordingly, the coexistence of cardiovascular and renal diseases inevitably means mediating between preserving renal function and improving cardiac activity to reach a better outcome.
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Affiliation(s)
- Giacomo Deferrari
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy.
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy.
| | - Adriano Cipriani
- Grown-Up Congentital Heart Disease Center (GUCH Center), Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Edoardo La Porta
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy
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25
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Elevated Creatinine-Based Estimated Glomerular Filtration Rate is Associated with Increased Risk of Sarcopenia, Dysphagia, and Reduced Functional Recovery after Stroke. J Stroke Cerebrovasc Dis 2021; 30:105491. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
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26
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Chua SK, Hsieh FI, Hu CJ, Wang IK, Lee JT, Yeh HL, Lin KY, Lai TC, Sun Y, Jeng JS, Lin CL, Lien LM, Hsu CY. Prognostic impact of renal dysfunction on embolic stroke of undetermined source-Role beyond CHA 2 DS 2 -VASc score: Results from Taiwan Stroke Registry. Eur J Neurol 2020; 28:1253-1264. [PMID: 33277744 DOI: 10.1111/ene.14662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The CHA2 DS2 -VASc score has immense prognostic value in patients with embolic stroke of undetermined source (ESUS). We aimed to determine the usefulness of advanced renal dysfunction and its addition to the CHA2 DS2 -VASc score in improving predictive accuracy. METHODS In total, 3775 ESUS patients were enrolled from a nationwide hospital-based prospective study. Advanced renal dysfunction was defined as estimated glomerular filtration rate <30 ml/min per 1.73 m2 or patients under dialysis. Clinical outcomes included recurrent stroke and 1-year all-cause mortality. Poor functional outcome was defined as a modified Rankin Scale >2 at first-, third-, and sixth-month post-stroke. The renal (R)-CHA2 DS2 -VASc score was derived by including advanced renal dysfunction in the CHA2 DS2 -VASc score. Risk stratification improvement after including advanced renal dysfunction was assessed using C statistic, integrated discrimination improvement (IDI), and category-free net reclassification index (NRI). RESULTS After adjusting for confounding factors and CHA2 DS2 -VASc score, advanced renal dysfunction showed significant associations with all-cause mortality (HR: 2.88, 95% CI: 1.92-4.34) and poor functional outcome at third- (OR: 2.69, 95% CI: 1.47-4.94) and sixth-month post-stroke (OR: 2.67, 95% CI: 1.47-4.83). IDI and NRI showed that incorporating advanced renal dysfunction significantly improved risk discrimination over the original CHA2 DS2 -VASc score. R-CHA2 DS2 -VASc score ≥2 increased risk by 1.94-fold (95% CI: 1.15-3.27) for all-cause mortality, and ≥4 increased risk by 1.62-fold (95% CI: 1.05-2.50) of poor functional outcome at third-month post-stroke and by 1.81-fold (95% CI: 1.19-2.75) at sixth-month post-stroke. CONCLUSIONS Advanced renal dysfunction was significantly associated with clinical and functional outcomes in ESUS patients and may improve prognostic impact of the CHA2 DS2 -VASc score.
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Affiliation(s)
- Su-Kiat Chua
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Fang-I Hsieh
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Kuan Wang
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsu-Ling Yeh
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kuan-Yu Lin
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ta-Chang Lai
- Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Li Lin
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan
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27
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Laszczyńska O, Severo M, Azevedo A. Definition of baseline renal function in hospitalised patients with multiple preadmission measures of serum creatinine—A joint modelling approach. Nephrology (Carlton) 2020; 25:897-905. [DOI: 10.1111/nep.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Olga Laszczyńska
- EPIUnit – Instituto de Saúde Pública Universidade do Porto Porto Portugal
| | - Milton Severo
- EPIUnit – Instituto de Saúde Pública Universidade do Porto Porto Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto Portugal
| | - Ana Azevedo
- EPIUnit – Instituto de Saúde Pública Universidade do Porto Porto Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica Faculdade de Medicina da Universidade do Porto Portugal
- Centro de Epidemiologia Hospitalar Centro Hospitalar Universitário de São João Porto Portugal
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28
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Shah B, Jagtap P, Sarmah D, Datta A, Raut S, Sarkar A, Bohra M, Singh U, Baidya F, Kalia K, Borah A, Dave KR, Yavagal DR, Bhattacharya P. Cerebro-renal interaction and stroke. Eur J Neurosci 2020; 53:1279-1299. [PMID: 32979852 DOI: 10.1111/ejn.14983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
Stroke is an event causing a disturbance in cerebral function leading to death and disability worldwide. Both acute kidney injury and chronic kidney disease (CKD) are associated with an increased risk of stroke and cerebrovascular events. The underlying mechanistic approach between impaired renal function and stroke is limitedly explored and has attracted researchers to learn more for developing therapeutic intervention. Common risk factors such as hypertension, hyperphosphatemia, atrial fibrillation, arteriosclerosis, hyperhomocysteinemia, blood-brain barrier disruption, inflammation, etc. are observed in the general population, but are high in renal failure patients. Also, risk factors like bone mineral metabolism, uremic toxins, and anemia, along with the process of dialysis in CKD patients, eventually increases the risk of stroke. Therefore, early detection of risks associated with stroke in CKD is imperative, which may decrease the mortality associated with it. This review highlights mechanisms by which kidney dysfunction can lead to cerebrovascular events and increase the risk of stroke in renal impairment.
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Affiliation(s)
- Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, India
| | - Kunjan R Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, India
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Zou Z, Chen S, Li Y, Cai J, Fang Y, Xie J, Fang W, Kang D, Xu Y. Risk factors for renal failure and short-term prognosis in patients with spontaneous intracerebral haemorrhage complicated by acute kidney injury. BMC Nephrol 2020; 21:311. [PMID: 32727417 PMCID: PMC7391601 DOI: 10.1186/s12882-020-01949-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
Background Although acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In this study, we aimed to identify the renal failure factors in SICH patents with AKI. Methods Five hundred forty-three patients with SICH complicated by differential severities of AKI who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were retrospectively studied. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Multivariate Cox regression analysis was performed to identify prognostic factors for renal recovery. Results In the multivariable adjusted model, we found that hypernatremia, metabolic acidosis, elevated serum creatine kinase, hyperuricaemia, proteinuria, and the use of colloids and diuretics were all independent risk factors for the occurrence of stage 3 AKI in SICH patients. The area under the curve analysis indicated that hypernatremia and hyperuricaemia were predictive factors for stage 3 AKI, and the combination of these two parameters increased their predictability for stage 3 AKI. Kaplan-Meier survival curves revealed that the renal recovery rate in SICH patients with stages 1 and 2 AKI was significantly higher than that in SICH patients with stage 3 AKI. Multivariate Cox regression analysis suggested that hypernatremia and the occurrence of stage 3 AKI are predictors for poor short-term renal recovery. Conclusions These findings illustrate that hypernatremia and hyperuricaemia represent potential risk factors for the occurrence of stage 3 AKI in SICH patients. Those patients with hypernatremia and stage 3 AKI were associated with a poor short-term prognosis in renal recovery.
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Affiliation(s)
- Zhenhuan Zou
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Siying Chen
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Yinshuang Li
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Jiawei Cai
- Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yulu Fang
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Jingzhi Xie
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Wenhua Fang
- Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Dezhi Kang
- Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yanfang Xu
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China.
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Shen Y, Wang J, Chen H, Li M, Chen M. Factors associated with renal impairment in Chinese patients with non-valvular AF and without an established renal disease: a cross-sectional study. Postgrad Med 2020; 132:452-457. [PMID: 32174239 DOI: 10.1080/00325481.2020.1739914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Renal impairment and atrial fibrillation (AF) often coexist. However, risk factors associated with renal impairment in AF patients have not been studied in a large population. Accordingly, this study investigated clinical factors associated with renal impairment in AF patients. METHODS From January 2012 to December 2016, 2,298 inpatients with non-valvular AF (NVAF) mainly for catheter ablation were enrolled in this cross-sectional study. Data collection included past medical history, echocardiography measurements, current medicine use and biochemical results. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Renal impairment was defined as a history of chronic kidney disease or an eGFR ≤90 ml/min/1.73 m2. Multivariate logistic regression was conducted to evaluate the relationship between the factors screened and eGFR. RESULTS The mean eGFR was 88.6 ± 17.1 ml/min/1.73 m2. The overall prevalence of renal impairment was 47.4%. Multivariate logistic regression showed that factors associated with renal impairment were age (OR: 1.12; 95% CI: 1.11-1.14), non-paroxysmal AF (OR: 1.28; 95% CI: 1.04-1.58), use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (OR: 1.58; 95% CI: 1.28-1.95), congestive heart failure (OR: 1.80; 95% CI: 1.05-3.07), left ventricular ejection fraction (LVEF) <50% (OR: 2.39; 95% CI: 1.34-4.28), and prior transient ischemic attack (TIA)/stroke/systematic embolism (SE) (OR: 2.69; 95% CI: 1.68-4.29). CONCLUSIONS Renal dysfunction is highly prevalent in Chinese NVAF patients and is significantly associated with older age, non-paroxysmal AF, use of ACEI/ARB, congestive heart failure, LVEF <50% and prior TIA/stroke/SE. Further studies on the mechanisms by which these risk factors affect renal function in NVAF patients need to be conducted.
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Affiliation(s)
- Youmei Shen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Jing Wang
- Division of Nephrology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China
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Al Shahawy AK, El-Gamasy MA, Elhakeem Seleem MA, Mawlana W, El Sharkaway AH. Assessment of cognitive functions and adaptive behavior in children with end-stage renal disease on regular hemodialysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:395-406. [PMID: 32394912 DOI: 10.4103/1319-2442.284014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic kidney disease (CKD) is defined by the Kidney Disease and Outcome Quality Initiative as a child who has kidney damage lasting for at least three months with or without decreased glomerular filtration rate. Hemodialysis (HD) means removal of waste products and extra fluid directly from the blood when the kidneys do not work properly. Studies aimed at investigating neurocognitive impairment in children with CKD have identified a wide range of delays in cognitive development. The aim of this study was to assess the cognitive functions and adaptive behavior in children with end-stage renal disease (ESRD) on regular HD. This case-controlled study was conducted on 30 children suffering from ESRD who were on treatment at the Pediatric Nephrology Unit of Tanta University Hospital. Thirty apparently healthy children served as a control group, in the period from January 2017 to January 2018. All children were subjected to full history taking, careful physical and neurological examination, specific investigations including assessment of intelligence quotient (IQ) using Stanford Binet test 5th edition; assessment of adaptive behavior, assessment of executive functions by using Wisconsin Card Sorting Test; and continuous performance test. This study showed that mean values of IQ and the Vineland test were significantly lower among patients than controls. The study suggests that children with ESRD had lower IQ, adaptive behavior and executive functions than healthy control children.
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Affiliation(s)
- Azza Kamal Al Shahawy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Gharbia Governate, Egypt
| | | | | | - Wegdan Mawlana
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Gharbia Governate, Egypt
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Balch MH, Nimjee SM, Rink C, Hannawi Y. Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke. J Stroke 2020; 22:159-172. [PMID: 32635682 PMCID: PMC7341014 DOI: 10.5853/jos.2019.02978] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
Stroke research has traditionally focused on the cerebral processes following ischemic brain injury, where oxygen and glucose deprivation incite prolonged activation of excitatory neurotransmitter receptors, intracellular calcium accumulation, inflammation, reactive oxygen species proliferation, and ultimately neuronal death. A recent growing body of evidence, however, points to far-reaching pathophysiological consequences of acute ischemic stroke. Shortly after stroke onset, peripheral immunodepression in conjunction with hyperstimulation of autonomic and neuroendocrine pathways and motor pathway impairment result in dysfunction of the respiratory, urinary, cardiovascular, gastrointestinal, musculoskeletal, and endocrine systems. These end organ abnormalities play a major role in the morbidity and mortality of acute ischemic stroke. Using a pathophysiology-based approach, this current review discusses the pathophysiological mechanisms following ischemic brain insult that result in end organ dysfunction. By characterizing stroke as a systemic disease, future research must consider bidirectional interactions between the brain and peripheral organs to inform treatment paradigms and develop effective, comprehensive therapeutics for acute ischemic stroke.
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Affiliation(s)
- Maria H.H. Balch
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shahid M. Nimjee
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cameron Rink
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yousef Hannawi
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Correspondence: Yousef Hannawi Department of Neurology, The Ohio State University Wexner Medical Center, Graves Hall, Suite 3172C, 333 West 10th Ave, Columbus, OH 43210, USA Tel: +1-614-685-7234 Fax: +1-614-366-7004 E-mail:
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Pan X, Zhou F, Shen R, Zhu Y, Arima H, Yang J, Zhou J. Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study. BMC Neurol 2020; 20:134. [PMID: 32290835 PMCID: PMC7155325 DOI: 10.1186/s12883-020-01720-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For acute ischemic stroke (AIS) patient receiving mechanical thrombectomy (MT), renal dysfunction was an independent risk factor of contrast-induced nephropathy which may affect clinical outcomes. However, the influence of renal function on stroke outcomes is still controversial. Thus, we aim to investigate the association between renal function and outcomes of AIS patients receiving MT. METHODS All consecutive stroke patients receiving MT were included in a prospective stroke registry in China from April 2015 to February 2019. Estimated glomerular filtration rate (eGFR) was measured on admission and categorized into G1 (≥ 90 ml/min/1.73 m2), G2 (60-89 ml/min/1.73 m2), G3a (45-59 ml/min/1.73 m2) and G3b-5 (≤44 ml/min/1.73 m2). Multivariable logistic regression analysis was performed to evaluate the association between eGFR and recanalization rate (thrombolysis in cerebral infarction scale 2b-3), symptomatic intracranial hemorrhage (sICH), death in hospital, death at 3 months and poor functional outcome (modified Rankin Scale 3-6 at 3 months). RESULTS A total of 373 patients were included in the study. Of them, 130 (34.9%) patients were in the eGFR group G1, 170 (45.6%) in G2, 46 (12.3%) in G3a, 27 (7.2%) in G3b-5. In multivariable logistic regression analysis, reduced eGFR was associated with increased risk of sICH (G3a, p = 0.016) and 3-month death (G3b-5, p = 0.025). However, no significant effects were observed between reduced eGFR and the risk of recanalization rate (p = 0.855), death in hospital (p = 0.970), and poor functional outcome (p = 0.644). CONCLUSIONS For AIS patients underwent MT, reduced eGFR was associated with increased risk of sICH and 3-month death. However, there were no appreciable effects of reduced eGFR on recanalization rate, death in hospital and 3-month functional outcome.
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Affiliation(s)
- Xiding Pan
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Shen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yubing Zhu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jie Yang
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Haas L, Eckart A, Haubitz S, Mueller B, Schuetz P, Segerer S. Estimated glomerular filtration rate predicts 30-day mortality in medical emergency departments: Results of a prospective multi-national observational study. PLoS One 2020; 15:e0230998. [PMID: 32251482 PMCID: PMC7135226 DOI: 10.1371/journal.pone.0230998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Renal failure is common in patients seeking help in medical emergency departments. Decreased renal function is associated with increased mortality in patients with heart failure or sepsis. In this study, the association between renal function (reflected by estimated glomerular filtration rate (eGFR) at the time of admission) and clinical outcome was evaluated. METHODS/OBJECTIVES Data was used from a prospective, multi-national, observational cohort of patients treated in three medical emergency departments of tertiary care centers. The eGFR was calculated from the creatinine at the time of admission (using the Chronic Kidney Disease-Epidemiology Collaboration equation,CKD-EPI). Uni- and multivariate regression models were used for eGFR and 30-day mortality, in hospital mortality, length of stay and intensive care unit admission rate. RESULTS 6983 patients were included. The 30-day mortality was 1.8%, 3.5%, 6.9%, 11.1%, 13.6%, and 14.2% in patients with eGFR of above 90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m2, respectively. Using multivariate regression, the adjusted odds ratio (OR) was 2.31 (for 15-29 ml/min/1.73m2, 95% confidence interval 1.36 to 3.90, p = 0.002) and 3.73 (for eGFR <15ml/min/1.73m2 as compared to >90 ml/min/1.73m2, 95% CI 2.04 to 6.84, p<0.001). For 10 ml/min/1.73m2 decrease in eGFR the OR for the 30-day mortality was 1.15 (95% CI1.09 to 1.22, p<0.001).The eGFR was also significantly associated with in-hospital mortality, the percentage of ICU-admissions, and with a longer hospital stay. No association was found with hospital readmission within 30 days. As limitations, only eGFR at admission was available and the number of patients on hemodialysis was unknown. CONCLUSION Reduced eGFR at the time of admission is a strong and independent predictor for adverse outcome in this large population of patients admitted to medical emergency departments.
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Affiliation(s)
- Laurent Haas
- Division of Nephrology, Dialysis and Transplantation, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- * E-mail:
| | - Andreas Eckart
- Division of Nephrology, Dialysis and Transplantation, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Dialysis and Transplantation, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Lima HDN, Saibel T, Colato G, Cabral NL. The impact of acute kidney injury on fatality of ischemic stroke from a hospital-based population in Joinville, Brazil. ACTA ACUST UNITED AC 2020; 41:323-329. [PMID: 31661544 PMCID: PMC6788834 DOI: 10.1590/2175-8239-jbn-2018-0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/18/2019] [Indexed: 11/21/2022]
Abstract
Introduction: The occurrence of acute kidney injury (AKI) after ischemic stroke has been
associated to a worse prognosis. There is a lack of Brazilian studies
evaluating this issue. This study aimed to describe the impact of AKI after
a first-ever ischemic stroke in relation to fatality rate in 30 days. Methods: This was a retrospective hospital-based cohort. We included patients who had
their first ischemic stroke between January to December 2015. AKI was
defined by an increase of serum creatinine in relation to baseline value at
admission ≥ 0.3 mg/dL or a rise in serum creatinine level by 1.5
times the baseline value at any point in the first week after admission. We
performed a univariate and multivariate analysis to evaluate the presence of
AKI with fatality in 30 days. Results: The final study population (n=214) had mean age of 66.46 ± 13.73
years, 48.1% were men, the mean NIHSS was 6.33 ± 6.27 and 20 (9.3%)
presented AKI. Patients with AKI were older, had a higher score on the
NIHSS, and had higher creatinine values on hospital discharge. The 30-day
mortality was higher in the AKI subgroup compared to non-AKI (35%
vs. 6.2%, p < 0.001). AKI was an
independent predictor of fatality after an ischemic stroke but limited by
severity of stroke (NIHSS). Conclusion: The presence of AKI is an important complication after ischemic stroke.
Despite its impact on 30-day fatality, the predictive strength of AKI was
limited by the severity of stroke.
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Affiliation(s)
| | - Tais Saibel
- Universidade da Região de Joinville, Departamento de Medicina, Joinville, SC, Brasil
| | - Gisele Colato
- Universidade da Região de Joinville, Departamento de Medicina, Joinville, SC, Brasil
| | - Norberto Luiz Cabral
- Universidade da Região de Joinville, Departamento de Medicina, Joinville, SC, Brasil
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Sutherland LJ, Diprose WK, Wang MTM, Barber PA. Chronic Kidney Disease and Outcome Following Endovascular Thrombectomy for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104665. [PMID: 32044221 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104665] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) is present in 20% to 35% of acute ischemic stroke patients and may increase the risk of poor functional outcome or death. We aimed to determine whether CKD was associated with worse outcome in stroke patients treated with endovascular thrombectomy (EVT). DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Consecutive EVT patients were identified from a prospective registry and dichotomized into patients with and without CKD, defined as an eGFR of less than 60 mL/min/1.73m2. The primary outcome was 3-month mortality following EVT. Secondary outcomes included symptomatic intracerebral hemorrhage (defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study), early neurological recovery (defined as change in National Institutes of Health Stroke Scale [NIHSS] score of ≥8 at 24 hours or an NIHSS of 0-1 at 24 hours) and functional independence (defined as a modified Rankin Scale [mRS] score of 0, 1 or 2) at 3 months. RESULTS 378 EVT patients (223 men; mean ± SD age 65 ± 15 years) were included. The median (IQR) admission eGFR was 71 (58-89) mL/min/1.73 m² and 117 (31%) patients had CKD. Multiple logistic regression adjusted for potential confounders demonstrated that CKD was a significant predictor of lower rates of functional independence (OR = .54, 95% CI, .31 to .90, P = .02), higher mRS scores (common OR = 1.78, 95% CI, 1.14 to 2.81, P = .01), and increased mortality (OR = 2.19, 95% CI, 1.16 to 4.12, P = .01). There was no association between CKD and early neurological recovery (OR = .92, 95% CI, .55 to 1.49, P = .71) or symptomatic intracerebral hemorrhage (OR = 1.18, 95% CI, .38 to 3.69, P = .77). CONCLUSIONS CKD was a significant predictor of worse functional outcome and mortality in stroke patients treated with EVT. The presence of CKD should not preclude patients from proceeding to EVT, but may help with prognostication and improve shared decision-making between patients, families and physicians.
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Affiliation(s)
- Luke J Sutherland
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - William K Diprose
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Michael T M Wang
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - P Alan Barber
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
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Pinier C, Gatault P, Fauchier L, Angoulvant D, François M, Barbet C, Bailly E, Noble J, Chevallier E, Rabot N, Büchler M, Sautenet B, Halimi JM. Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view. Clin Kidney J 2020; 13:17-23. [PMID: 32083616 PMCID: PMC7025370 DOI: 10.1093/ckj/sfz028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established renal risk factors is unclear in type 2 diabetes mellitus. METHODS We conducted a retrospective study in 861 consecutive patients followed in a nephrology setting during the 2000-13 period. RESULTS The mean age was 70 ± 10 years, 65.1% were men and the estimated glomerular filtration rate (eGFR) was 42.4 ± 21.0 mL/min/1.73 m2. During follow-up (median 59 months), 194 patients reached ESRD. A history of AF, HF or ACS was associated with an increased risk of reduced baseline eGFR. In turn, reduced baseline eGFR resulted in a greater risk of new MCVE (especially HF) during follow-up. Finally, all new MCVEs were risk factors for subsequent acute kidney injury (AKI) {HF: hazard ratio [HR] 8.99 [95% confidence interval (CI) 7.06-11.4]; AF: HR 5.42 (3.91-7.52); ACS: HR 8.82 (6.24-12.5); all P < 0.0001} and ESRD [HF: HR 5.52 (95% CI 4.01-7.60), P < 0.0001; AF: HR 3.48 (2.30-5.21), P < 0.0001; ACS: HR 2.31 (1.43-3.73), P = 0.0006]. The AF- and HF-associated risks of ESRD were significant after adjustments on all renal risks of ESRD (gender, blood pressure, eGFR, albuminuria, renin-angiotensin blockers, retinopathy and AKI), but the association was less strong for ACS. Importantly, no association was noted between other major events such as stroke or infections and the risk of ESRD. CONCLUSIONS Past and new cardiovascular events (more HF and AF than ACS) have a strong, independent impact on the development of ESRD above and beyond established risk factors in diabetes.
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Affiliation(s)
- Cédric Pinier
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Philippe Gatault
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- EA4245, François-Rabelais University, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Denis Angoulvant
- EA4245, François-Rabelais University, Tours, France
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Maud François
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Christelle Barbet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Elodie Bailly
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Johan Noble
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Eloi Chevallier
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Nolwenn Rabot
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Matthias Büchler
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- EA4245, François-Rabelais University, Tours, France
| | - Bénédicte Sautenet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- Inserm U1246, François-Rabelais University, Tours, France
- FCRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- EA4245, François-Rabelais University, Tours, France
- FCRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France
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Nakuluri K, Nishad R, Mukhi D, Kumar S, Nakka VP, Kolligundla LP, Narne P, Natuva SSK, Phanithi PB, Pasupulati AK. Cerebral ischemia induces TRPC6 via HIF1α/ZEB2 axis in the glomerular podocytes and contributes to proteinuria. Sci Rep 2019; 9:17897. [PMID: 31784544 PMCID: PMC6884642 DOI: 10.1038/s41598-019-52872-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
Podocytes are specialized cells of the glomerulus and key component of the glomerular filtration apparatus (GFA). GFA regulates the permselectivity and ultrafiltration of blood. The mechanism by which the integrity of the GFA is compromised and manifest in proteinuria during ischemic stroke remains enigmatic. We investigated the mechanism of ischemic hypoxia-induced proteinuria in a middle cerebral artery occlusion (MCAO) model. Ischemic hypoxia resulted in the accumulation of HIF1α in the podocytes that resulted in the increased expression of ZEB2 (Zinc finger E-box-binding homeobox 2). ZEB2, in turn, induced TRPC6 (transient receptor potential cation channel, subfamily C, member 6), which has increased selectivity for calcium. Elevated expression of TRPC6 elicited increased calcium influx and aberrant activation of focal adhesion kinase (FAK) in podocytes. FAK activation resulted in the stress fibers reorganization and podocyte foot process effacement. Our study suggests overactive HIF1α/ZEB2 axis during ischemic-hypoxia raises intracellular calcium levels via TRPC6 and consequently altered podocyte structure and function thus contributes to proteinuria.
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Affiliation(s)
| | - Rajkishor Nishad
- Department of Biochemistry, University of Hyderabad, Hyderabad, 500046, India
| | - Dhanunjay Mukhi
- Department of Biochemistry, University of Hyderabad, Hyderabad, 500046, India
| | - Sireesh Kumar
- Department of Biotechnology & Bioinformatics, University of Hyderabad, Hyderabad, 500046, India
| | - Venkata P Nakka
- Department of Biochemistry, Acharya Nagarjuna University, Guntur, 522510, India
| | | | - Parimala Narne
- Department of Biotechnology & Bioinformatics, University of Hyderabad, Hyderabad, 500046, India
| | | | - Prakash Babu Phanithi
- Department of Biotechnology & Bioinformatics, University of Hyderabad, Hyderabad, 500046, India.
| | - Anil K Pasupulati
- Department of Biochemistry, University of Hyderabad, Hyderabad, 500046, India.
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Ntaios G, Lip GYH, Lambrou D, Michel P, Perlepe K, Eskandari A, Nannoni S, Sirimarco G, Strambo D, Vemmos K, Koroboki E, Manios E, Vemmou A, Rodríguez-Campello A, Cuadrado-Godia E, Roquer J, Arnao V, Caso V, Paciaroni M, Diez-Tejedor E, Fuentes B, Rodríguez Pardo J, Arauz A, Ameriso SF, Pertierra L, Gómez-Schneider M, Hawkes MA, Bandini F, Chavarria Cano B, Mohedano AMI, García Pastor A, Gil-Núñez A, Putaala J, Tatlisumak T, Barboza MA, Karagkiozi E, Makaritsis K, Papavasileiou V. Renal Function and Risk Stratification of Patients With Embolic Stroke of Undetermined Source. Stroke 2019; 49:2904-2909. [PMID: 30571398 DOI: 10.1161/strokeaha.118.023281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background and Purpose- We aimed to assess if renal function can aid in risk stratification for ischemic stroke or transient ischemic attack (TIA) recurrence and death in patients with embolic stroke of undetermined source (ESUS). Methods- We pooled 12 ESUS datasets from Europe and America. Renal function was evaluated using the estimated glomerular filtration rate (eGFR) and analyzed in continuous, binary, and categorical way. Cox-regression analyses assessed if renal function was independently associated with the risk for ischemic stroke/TIA recurrence and death. The Kaplan-Meier product limit method estimated the cumulative probability of ischemic stroke/TIA recurrence and death. Results- In 1530 patients with ESUS followed for 3260 patient-years, there were 237 recurrences (15.9%) and 201 deaths (13.4%), corresponding to 7.3 ischemic stroke/TIA recurrences and 5.6 deaths per 100 patient-years, respectively. Renal function was not associated with the risk for ischemic stroke/TIA recurrence when forced into the final multivariate model, regardless if it was analyzed as continuous (hazard ratio, 1.00; 95% CI, 0.99-1.00 for every 1 mL/min), binary (hazard ratio, 1.27; 95% CI, 0.87-1.73) or categorical covariate (likelihood-ratio test 2.59, P=0.63 for stroke recurrence). The probability of ischemic stroke/TIA recurrence across stages of renal function was 11.9% for eGFR ≥90, 16.6% for eGFR 60-89, 21.7% for eGFR 45-59, 19.2% for eGFR 30-44, and 24.9% for eGFR <30 (likelihood-ratio test 2.59, P=0.63). The results were similar for the outcome of death. Conclusions- The present study is the largest pooled individual patient-level ESUS dataset, and does not provide evidence that renal function can be used to stratify the risk of ischemic stroke/TIA recurrence or death in patients with ESUS.
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Affiliation(s)
- George Ntaios
- From the Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N, D.L., K.P., A.V., E.K., V.P.)
| | - Gregory Y H Lip
- Institute of Cardiovascular Science, University of Birmingham, United Kingdom (G.Y.H.L.).,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (G.Y.H.L.).,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Dimitris Lambrou
- From the Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N, D.L., K.P., A.V., E.K., V.P.)
| | - Patrik Michel
- Stroke Center, Lausanne University Hospital, Switzerland (P.M., K.P., A.E., S.N., G.S., D.S.)
| | - Kalliopi Perlepe
- From the Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N, D.L., K.P., A.V., E.K., V.P.).,Stroke Center, Lausanne University Hospital, Switzerland (P.M., K.P., A.E., S.N., G.S., D.S.)
| | - Ashraf Eskandari
- Stroke Center, Lausanne University Hospital, Switzerland (P.M., K.P., A.E., S.N., G.S., D.S.)
| | - Stefania Nannoni
- Stroke Center, Lausanne University Hospital, Switzerland (P.M., K.P., A.E., S.N., G.S., D.S.)
| | - Gaia Sirimarco
- Stroke Center, Lausanne University Hospital, Switzerland (P.M., K.P., A.E., S.N., G.S., D.S.)
| | - Davide Strambo
- Stroke Center, Lausanne University Hospital, Switzerland (P.M., K.P., A.E., S.N., G.S., D.S.)
| | | | - Eleni Koroboki
- First Department of Neurology, National and Kapodistrian University of Athens, Greece (E.K.).,Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, United Kingdom (E.K.)
| | - Efstathios Manios
- Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece (E.M.)
| | - Anastasia Vemmou
- From the Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N, D.L., K.P., A.V., E.K., V.P.)
| | - Ana Rodríguez-Campello
- Stroke Unit, Department of Neurology, Hospital del Mar. Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d' Investigacions Mèdiques), Universitat Autònoma de Barcelona, Spain (A.R.-C., E.C.-G., J.R.)
| | - Elisa Cuadrado-Godia
- Stroke Unit, Department of Neurology, Hospital del Mar. Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d' Investigacions Mèdiques), Universitat Autònoma de Barcelona, Spain (A.R.-C., E.C.-G., J.R.)
| | - Jaume Roquer
- Stroke Unit, Department of Neurology, Hospital del Mar. Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d' Investigacions Mèdiques), Universitat Autònoma de Barcelona, Spain (A.R.-C., E.C.-G., J.R.)
| | - Valentina Arnao
- Stroke Unit, University of Perugia, Italy (V.A., V.C., M.P.)
| | - Valeria Caso
- Stroke Unit, University of Perugia, Italy (V.A., V.C., M.P.)
| | | | - Exuperio Diez-Tejedor
- Department of Neurology and Stroke Center, La Paz University Hospital - Autónoma University of Madrid, IdiPAZ Health Research Institute, Spain (E.D.-T., B.F., J.R.P.)
| | - Blanca Fuentes
- Department of Neurology and Stroke Center, La Paz University Hospital - Autónoma University of Madrid, IdiPAZ Health Research Institute, Spain (E.D.-T., B.F., J.R.P.)
| | - Jorge Rodríguez Pardo
- Department of Neurology and Stroke Center, La Paz University Hospital - Autónoma University of Madrid, IdiPAZ Health Research Institute, Spain (E.D.-T., B.F., J.R.P.)
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (A.A.)
| | - Sebastian F Ameriso
- Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina (S.F.A., L.P., M.G.-S.)
| | - Lucía Pertierra
- Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina (S.F.A., L.P., M.G.-S.)
| | - Maia Gómez-Schneider
- Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina (S.F.A., L.P., M.G.-S.)
| | - Maximiliano A Hawkes
- Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, Rochester, Minnesota (M.A.H.)
| | | | - Beatriz Chavarria Cano
- Department of Neurology, San Paolo Hospital, Savona, Italy (B.C.C., A.M.I.M., A.G.P., A.G.-N.).,Vascular Neurology Section, Stroke Center, Hospital General Universitario Gregorio Marañón, IiSGM Health Research Institute, Universidad Complutense de Madrid, Spain (B.C.C., A.M.I.M., A.G.P., A.G.-N.)
| | - Ana Maria Iglesias Mohedano
- Department of Neurology, San Paolo Hospital, Savona, Italy (B.C.C., A.M.I.M., A.G.P., A.G.-N.).,Vascular Neurology Section, Stroke Center, Hospital General Universitario Gregorio Marañón, IiSGM Health Research Institute, Universidad Complutense de Madrid, Spain (B.C.C., A.M.I.M., A.G.P., A.G.-N.)
| | - Andrés García Pastor
- Department of Neurology, San Paolo Hospital, Savona, Italy (B.C.C., A.M.I.M., A.G.P., A.G.-N.)
| | - Antonio Gil-Núñez
- Department of Neurology, San Paolo Hospital, Savona, Italy (B.C.C., A.M.I.M., A.G.P., A.G.-N.).,Vascular Neurology Section, Stroke Center, Hospital General Universitario Gregorio Marañón, IiSGM Health Research Institute, Universidad Complutense de Madrid, Spain (B.C.C., A.M.I.M., A.G.P., A.G.-N.)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital and University of Helsinki, Finland (J.P., T.T.)
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital and University of Helsinki, Finland (J.P., T.T.).,Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.).,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, University of Costa Rica (M.A.B.)
| | - Efstathia Karagkiozi
- From the Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N, D.L., K.P., A.V., E.K., V.P.)
| | | | - Vasileios Papavasileiou
- From the Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N, D.L., K.P., A.V., E.K., V.P.).,Stroke Service, Department of Neurosciences, Leeds Teaching Hospitals NHS Trust and Medical School, University of Leeds, United Kingdom (V.P.)
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El Husseini N, Fonarow GC, Smith EE, Ju C, Sheng S, Schwamm LH, Hernandez AF, Schulte PJ, Xian Y, Goldstein LB. Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. Stroke 2019; 49:2896-2903. [PMID: 30571413 DOI: 10.1161/strokeaha.118.022011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background and Purpose- Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods- In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results- Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66-2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49-2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95-2.26 and HR, 2.55; 95% CI, 2.44-2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90-2.18 and HR, 2.46; 95% CI, 2.36-2.56, respectively). Conclusions- Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.
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Affiliation(s)
- Nada El Husseini
- From the Department of Neurology, Wake Forest Baptist University Medical Center, Winston-Salem, NC (N.E.H.).,Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC
| | - Gregg C Fonarow
- UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Canada (E.E.S.)
| | - Christine Ju
- Duke Clinical Research Institute (C.J., S.S., A.F.H., P.J.S., Y.X.), Duke University Medical Center, Durham, NC
| | - Shubin Sheng
- Duke Clinical Research Institute (C.J., S.S., A.F.H., P.J.S., Y.X.), Duke University Medical Center, Durham, NC
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.)
| | - Adrian F Hernandez
- Duke Clinical Research Institute (C.J., S.S., A.F.H., P.J.S., Y.X.), Duke University Medical Center, Durham, NC
| | - Phillip J Schulte
- Duke Clinical Research Institute (C.J., S.S., A.F.H., P.J.S., Y.X.), Duke University Medical Center, Durham, NC.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.)
| | - Ying Xian
- Duke Clinical Research Institute (C.J., S.S., A.F.H., P.J.S., Y.X.), Duke University Medical Center, Durham, NC.,Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC
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Chelluboina B, Vemuganti R. Chronic kidney disease in the pathogenesis of acute ischemic stroke. J Cereb Blood Flow Metab 2019; 39:1893-1905. [PMID: 31366298 PMCID: PMC6775591 DOI: 10.1177/0271678x19866733] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease has a graded and independent inverse impact on cerebrovascular health. Both thrombotic and hemorrhagic complications are highly prevalent in chronic kidney disease patients. Growing evidence suggests that in chronic kidney disease patients, ischemic strokes are more common than hemorrhagic strokes. Chronic kidney disease is asymptomatic until an advanced stage, but mild to moderate chronic kidney disease incites various pathogenic mechanisms such as inflammation, oxidative stress, neurohormonal imbalance, formation of uremic toxins and vascular calcification which damage the endothelium and blood vessels. Cognitive dysfunction, dementia, transient infarcts, and white matter lesions are widespread in mild to moderate chronic kidney disease patients. Uremic toxins produced after chronic kidney disease can pass through the blood-brain barrier and mediate cognitive dysfunction and neurodegeneration. Furthermore, chronic kidney disease precipitates vascular risk factors that can lead to atherosclerosis, hypertension, atrial fibrillation, and diabetes. Chronic kidney disease also exacerbates stroke pathogenesis, worsens recovery outcomes, and limits the eligibility of stroke patients to receive available stroke therapeutics. This review highlights the mechanisms involved in the advancement of chronic kidney disease and its possible association with stroke.
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Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Veterans Administration Hospital, Madison, WI, USA
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Gong Y, Ding F, Zhang F, Gu Y. Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury. J Investig Med 2019; 67:1103-1109. [PMID: 31575668 PMCID: PMC6900215 DOI: 10.1136/jim-2019-001003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Abstract
Although significant improvements have been achieved in the renal replacement therapy of acute kidney injury (AKI), the mortality of patients with AKI remains high. The aim of this study is to prospectively investigate the capacity of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II), Sepsis-related Organ Failure Assessment (SOFA) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) to predict in-hospital mortality of critically ill patients with AKI. A prospective observational study was conducted in a university teaching hospital. 189 consecutive critically ill patients with AKI were selected according Risk, Injury, Failure, Loss, or End-stage kidney disease criteria. APACHE II, SAPS II, SOFA and ATN-ISI counts were obtained within the first 24 hours following admission. Receiver operating characteristic analyses (ROCs) were applied. Area under the ROC curve (AUC) was calculated. Sensitivity and specificity of in-hospital mortality prediction were calculated. In this study, the in-hospital mortality of critically ill patients with AKI was 37.04% (70/189). AUC of APACHE II, SAPS II, SOFA and ATN-ISI was 0.903 (95% CI 0.856 to 0.950), 0.893 (95% CI 0.847 to 0.940), 0.908 (95% CI 0.866 to 0.950) and 0.889 (95% CI 0.841 to 0.937) and sensitivity was 90.76%, 89.92%, 90.76% and 89.08% and specificity was 77.14%, 70.00%, 71.43% and 71.43%, respectively. In this study, it was found APACHE II, SAPS II, SOFA and ATN-ISI are reliable in-hospital mortality predictors of critically ill patients with AKI. Trial registration number: NCT00953992.
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Affiliation(s)
- Yu Gong
- Department of Internal Medicine, Division of Nephrology, Shanghai Municipal Eighth People's Hospital, Shanghai, China
| | - Feng Ding
- Huashan Hospital, Fudan University, Shanghai, China
| | - Fen Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Yong Gu
- Huashan Hospital, Fudan University, Shanghai, China
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Feng JL. Incidence and Predictors of Sudden Cardiac Death After a Major Non-Fatal Cardiovascular Event. Heart Lung Circ 2019; 29:679-686. [PMID: 31109887 DOI: 10.1016/j.hlc.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/02/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) still accounts for the majority of deaths from the four major cardiovascular events (myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), and stroke) despite substantial progress on prevention. METHODS Four separate cohorts (one for each of the four major cardiovascular conditions) were captured through person-linked hospital morbidity and mortality data collections between 2000 and 2009 and followed-up for 11.5 years. The incidence rate for each cohort was total SCD cases divided by sum of follow-up time for each individual alive. Kaplan-Meier survival curve was used to calculate unadjusted risk of SCD. Predictors of SCD were identified by fitting multivariable adjusted Cox regression models in each of the cohorts. RESULTS There were 1,174 cases of SCD from 53,614 total CVD events across the cohorts (35.6% for MI, 15.6% for HF, 22.4% for AF, 26.4% for stroke). The incidence rate and unadjusted risk of SCD were both highest after incident hospitalisation for HF, followed by MI, stroke and AF. The elevated risk of SCD was independently associated with MI, HF, arrhythmias, peripheral artery disease, diabetes, chronic kidney disease, and prior coronary heart disease (hazard ratios ranging from 1.1 to 2.8). Early revascularisation is protective in 28-day survivors after an incident MI event. CONCLUSIONS An appreciable incidence of SCD following an incident event of MI, HF, AF and stroke deserves greater prevention efforts. Major medical conditions such as MI, HF, peripheral artery disease, and arrhythmias are risk markers of SCD and coronary revascularisation is protective.
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Affiliation(s)
- Jia-Li Feng
- School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia.
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Deng L, Qiu S, Wang C, Bian H, Wang L, Li Y, Wu B, Liu M. Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus. BMC Neurol 2019; 19:63. [PMID: 30987606 PMCID: PMC6463662 DOI: 10.1186/s12883-019-1290-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 03/31/2019] [Indexed: 02/05/2023] Open
Abstract
Background The effect of the blood urea nitrogen (BUN) to creatinine (Cr) ratio (henceforth BUN/Cr) on haemorrhagic transformation (HT) of acute ischaemic stroke (AIS) patients is unclear. Methods AIS patients in the West China Hospital, Sichuan University, Chengdu, China, admitted within seven days from stroke onset (2012–2016) were included in the study. Baseline data, including BUN and Cr levels, were collected. The outcome was defined as HT during hospitalization. Results In this study, 1738 participants with an average age of 62.7 ± 14.0 years were included. After adjusting potential confounders (age, blood platelet, albumin, stroke severity, triglycerides and low-density lipoprotein [LDL]), multivariate logistic regression analyses indicated that BUN/Cr is independently associated with HT. The nonlinear relation between BUN/Cr and HT was explored in a dose-dependent manner, with an apparent inflection point of 30.71. On the left and right sides of the inflection point, the odds ratio (OR) and 95% confidence interval (CI) were 1.05 (1.02–1.08) and 0.96 (0.88–1.05), respectively. Interaction between BUN/Cr and diabetes mellitus (DM) and HT (P for interaction = 0.0395) was noted. BUN/Cr showed positive correlation with HT in DM patients (OR = 1.07; 95% CI: [1.02, 1.12]) but no significant relationship with HT in patients without DM. Conclusion BUN/Cr is significantly associated with HT in AIS patients in a linear fashion, with an apparent cut point demarcating the HT difference. When the patients have DM, BUN/Cr is positively correlated with HT. These results support a revision in how we anticipate the prognosis for AIS patients. Electronic supplementary material The online version of this article (10.1186/s12883-019-1290-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linghui Deng
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Center of Biomedical big data, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changyi Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haiyang Bian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxiao Li
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Ming Liu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Cheng YL, Sung SH, Cheng HM, Huang JT, Guo CY, Hsu PF, Yu WC, Chen CH. Prognostic Comparison of the Estimations of Renal Function in Patients With Acute Heart Failure. Circ J 2019; 83:767-774. [PMID: 30787217 DOI: 10.1253/circj.cj-18-1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic significance of the eGFR calculated by either the four-level Race Chronic Kidney Disease-Epidemiology Collaboration study equation (CKD-EPI4R) or the Chinese-modified Modification of Diet in Renal Disease equation (cMDRD) has not been compared in Asian populations with acute heart failure (AHF).Methods and Results:A total of 3,044 patients hospitalized for AHF were enrolled. The National Death Registry was linked to identify deaths within a 5-year follow-up. Net reclassification improvement (NRI) was calculated to compare the prognostic value of either eGFR equation. During a median follow-up of 23.3 months, 1,424 (47%) patients died. Both eGFRcMDRDand eGFRCKD-EPI4Rwere independently predictive of death in the total study population (hazard ratio and 95% confidence intervals per 1-SD: 0.76, 0.71-0.81 and 0.74, 0.70-0.79, respectively), and in the subgroups of either reduced (HFrEF) or preserved (HFpEF) ejection fraction, after accounting for important confounders. With reference to eGFRcMDRD, eGFRCKD-EPI4Rmay improve the NRI by 2.0% (0.8-3.2%) for the prediction of death. The prognostic value of the CKD stages categorized by eGFRCKD-EPI4Rsignificantly outperformed eGFRcMDRDwith a categorical NRI of 9.5% (4.7-14.3%) in the total study population, 11.5% in HFrEF, and 8.3% in HFpEF. CONCLUSIONS Both eGFRcMDRDand eGFRCKD-EPI4Rwere independently associated with long-term survival in patients with AHF. However, the CKD stages derived from eGFRCKD-EPI4Rimproved the risk stratification of death, compared with eGFRcMDRD.
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Affiliation(s)
- Yu-Lun Cheng
- Department of Medicine, Taipei Veterans General Hospital.,Department of Medicine, National Yang-Ming University.,Institute of Public Health, National Yang-Ming University
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital.,Department of Medicine, National Yang-Ming University.,Institute of Public Health, National Yang-Ming University
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital.,Cardiovascular Research Center, National Yang-Ming University.,Department of Medicine, National Yang-Ming University
| | - Jui-Tzu Huang
- Department of Medicine, National Yang-Ming University
| | - Chao-Yu Guo
- Institute of Public Health, National Yang-Ming University
| | - Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital.,Department of Medicine, National Yang-Ming University.,Institute of Public Health, National Yang-Ming University
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital.,Cardiovascular Research Center, National Yang-Ming University.,Department of Medicine, National Yang-Ming University
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital.,Cardiovascular Research Center, National Yang-Ming University.,Department of Medicine, National Yang-Ming University.,Institute of Public Health, National Yang-Ming University
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Ansaritoroghi M, Nagaraju SP, Nair RP, Kumar V, Kongwad LI, Attur RP, Ramachandran GM, Hegde A. Study on Acute Kidney Injury in Patients with Spontaneous Intracerebral Hemorrhage: an Overview from a Tertiary Care Hospital in South India. World Neurosurg 2018; 123:e740-e746. [PMID: 30579025 DOI: 10.1016/j.wneu.2018.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is an independent risk factor for adverse clinical outcomes in patients with hemorrhagic stroke. There is limited data regarding the occurrence and impact of AKI in the setting of spontaneous intracerebral hemorrhage (SICH). Considering this, we sought to determine the incidence and risk factors for AKI in patients with SICH and to determine the role of AKI on SICH mortality in our population. MATERIALS AND METHODS This is a retrospective analysis of the data recorded in the stroke registry maintained by the Department of Neurosurgery, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education after ethical committee clearance. Information regarding clinical features, demographics, laboratory data, prescribing patterns, and the use of contrast-mediated imaging were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Logistic multivariate regression was used to determine predictors of AKI. Analysis of variance was used to measure the effect of AKI on SICH outcome. RESULTS Of 316 patients with SICH admitted to the hospital, 20% of patients developed AKI. It was found that risk factors for AKI were lower baseline estimated glomerular filtration rate (odds ratio, 1.60; 95% confidence interval, 1.21 SICH 2.2; P < 0.001) and infectious complications (odds ratio, 3.37; 95% confidence interval, 1.9-5.7; P < 0.001). The incidence of 30 days' mortality was higher in the group with AKI (14% vs. 5.5%). There was a significant association between AKI severity and short-term mortality (P < 0.001). Patients with AKI had a lower Glasgow Coma Scale on admission (11.81 ± 3.17 vs. 10.83 ± 3.2) and discharge (12.44 ± 3.44 vs. 10.38 ± 3.2) compared to patients without AKI (P < 0.001). Greater severity of AKI was associated with worse neurologic outcome (P < 0.001). DISCUSSION Various studies in literature have evaluated the incidence of AKI after a stroke episode. The incidence of AKI was ranging from 8%-21% in those studies. In our study, we found that 20% of SICH patients developed AKI. The incidence of AKI in our study falls along the spectrum described in these previous studies. CONCLUSIONS AKI is a common complication of SICH. Lower estimated glomerular filtration rate at admission and infections were the significant risk factors. Patients with AKI had poor neurologic outcome and higher mortality and it increased with the severity of AKI.
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Affiliation(s)
- Marzieh Ansaritoroghi
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
| | - Rajesh Parameshwaran Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India.
| | - Vinod Kumar
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
| | - Lakshman I Kongwad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
| | - Ravindra Prabhu Attur
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
| | - Girish Menon Ramachandran
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
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Dynamic Changes in the Estimated Glomerular Filtration Rate Predict All-Cause Mortality After Intravenous Thrombolysis in Stroke Patients. Neurotox Res 2018; 35:441-450. [DOI: 10.1007/s12640-018-9970-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/22/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023]
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Billington CK, Appleton JP, Berge E, Sprigg N, Glover M, Bath PMW. Impact of hydration status on haemodynamics, effects of acute blood pressure-lowering treatment, and prognosis after stroke. Br J Clin Pharmacol 2018; 84:2914-2922. [PMID: 30194849 PMCID: PMC6256053 DOI: 10.1111/bcp.13761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Although high blood pressure (BP) is common in acute stroke and associated with poor outcome, the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients. We assessed the impact of dehydration on haemodynamics, the effects of antihypertensive treatment, and prognosis in the ENOS trial. Methods ENOS randomized 4011 patients with acute stroke and raised systolic BP to a glyceryl trinitrate (GTN) patch or no GTN patch, and to continue or to stop existing antihypertensive treatment within 48 h of onset. The primary outcome was functional outcome (modified Rankin Scale, mRS) at day 90. Blood markers of dehydration at baseline were collected at two sites (n = 310) and their relationship with haemodynamics and outcome was assessed. Results There were no significant associations between dehydration markers and fall in blood pressure from baseline to day 1, and no significant interaction with allocated treatment. Overall, increasing urea was associated with an unfavourable shift in mRS [odds ratio 3.43, 95% confidence interval (CI) 1.42, 8.32; P = 0.006] and increased risk of death at day 90 (hazard ratio 4.55, 95% CI 1.51, 13.66; P = 0.007). Conclusions Blood pressure‐lowering treatment was safe in dehydrated patients, with no precipitous changes in BP, thus supporting its use in acute stroke prior to blood markers of dehydration becoming available. Increased baseline urea was associated with poor prognosis after stroke.
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Affiliation(s)
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Oslo, Norway
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Mark Glover
- Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Philip M W Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke. Atherosclerosis 2018; 277:15-20. [PMID: 30170219 DOI: 10.1016/j.atherosclerosis.2018.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/11/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023]
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The Impact of Uremic Toxins on Cerebrovascular and Cognitive Disorders. Toxins (Basel) 2018; 10:toxins10070303. [PMID: 30037144 PMCID: PMC6071092 DOI: 10.3390/toxins10070303] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022] Open
Abstract
Individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia. Stroke is also highly prevalent in this population and is associated with a higher risk of neurological deterioration, in-hospital mortality, and poor functional outcomes. Evidence from in vitro studies and in vivo animal experiments suggests that accumulation of uremic toxins may contribute to the pathogenesis of stroke and amplify vascular damage, leading to cognitive disorders and dementia. This review summarizes current evidence on the mechanisms by which uremic toxins may favour the occurrence of cerebrovascular diseases and neurological complications in CKD.
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