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Maeda T, Woodward M, Jun M, Sakamoto Y, Chen X, Matsushita K, Mancia G, Arima H, Anderson CS, Chalmers J, Harris K. Risk of recurrent stroke and dementia following acute stroke by changes in kidney function: results from the Perindopril Protection Against Recurrent Stroke Study. J Hypertens 2024; 42:1313-1321. [PMID: 38690898 DOI: 10.1097/hjh.0000000000003711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Limited data exist on the relationship between declining kidney function and cardiovascular events, dementia, and mortality in patients with a history of stroke.Thus the aims of the study were to investigate functional relationships between dynamic kidney function change and cardiovascular outcomes, and clarify whether adding kidney parameters to conventional cardiovascular risk factors improves model discrimination. METHODS Post hoc analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) clinical trial of blood pressure lowering for the secondary prevention of stroke. We examined the association between dynamic kidney function defined as percentage change (declines of >30%, and >0 to ≤30%, and increases of ≥0 to <30%, and ≥30%) in estimated glomerular filtration rate (eGFR) over 2 years and recurrent stroke, major cardiovascular events, dementia and all-cause death over the next 2 years using Cox proportional hazard models controlling for eGFR at registration and potential confounders. Restricted cubic splines were used to assess the functional relationships. C-statistics and Net Reclassification Improvement (NRI) at 2 years were used to assess model discrimination. RESULTS In 4591 patients followed for a mean of approximately 2 years, 254 (5.5%) developed recurrent stroke, 391 (8.5%) had a major cardiovascular event, 221 (4.8%) developed dementia, and 271 (5.9%) died. Reverse J-like or U-like relationships were observed for percent declines in eGFR and outcomes. Using declines in eGFR of >0 to ≤30% as a reference, increased risks were evident for a greater decline (>30%) in relation to recurrent stroke [adjusted hazard ratio 1.85, 95% confidence interval (CI) 1.20-2.85], major cardiovascular event (2.24, 1.62-3.10) and all-cause death (2.09, 1.39-3.15). A larger increase (≥30%) in eGFR was also associated with a greater risk of all-cause death (1.96, 1.14-3.37). Improvements in the C-statistic were found by adding baseline eGFR and percent change compared with a model with conventional cardiovascular risk factors alone, for major cardiovascular events, dementia, and all-cause mortality. CONCLUSION Declining kidney function following an incident cerebrovascular event is associated with additional risk of a major cardiovascular events, dementia, and 2-year mortality. However, a large increase in kidney function was also found to be associated with a higher risk of mortality.
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Affiliation(s)
- Toshiki Maeda
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yuki Sakamoto
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Xiaoying Chen
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Li K, Hou Q, Li X, Tian L, Wang L, Wu S, Han Q. Triglyceride-glucose index predicts major adverse cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2024; 56:2793-2802. [PMID: 38536621 DOI: 10.1007/s11255-024-04005-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/05/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND PURPOSE Triglyceride-glucose (TyG) index has been regarded as a reliable surrogate marker of insulin resistance for predicting cardiovascular outcomes. The current study aimed to explore the associations between TyG index with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). METHODS/PATIENTS 13,517 patients with chronic kidney disease (CKD) from the Kailuan study were included. Patients were divided into quartiles according to the TyG index. The outcomes were MACE, including acute myocardial infarction (AMI) and ischemic stroke (IS). The association between TyG index and the risk of MACE was analyzed by Cox regression models. RESULTS During 13.87-year follow-up, a total 1356 MACEs occurred. Multivariable Cox proportional-hazards analyses showed that a higher TyG index quartile was associated with an elevated risk of MACE. CONCLUSIONS TyG index is significantly related to MACE in patients with CKD. TyG index can be regarded as a novel predictor of MACE for patients with CKD.
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Affiliation(s)
- Kangbo Li
- Department of Internal Medicine, Wenfeng District Xiguan Subdistrict Office Community Health Center, Anyang, China
| | - Qiqi Hou
- Hebei Medical University, Shijiazhuang, China
| | - Xinyi Li
- School of Clinical Medicine, Xiangnan University, Chenzhou, China
| | - Liying Tian
- Catheterization Unit, Tangshan Gongren Hospital, Tangshan, China
| | - Liyan Wang
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Quanle Han
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China.
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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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Liao CC, Liu CC, Lee YW, Chang CC, Yeh CC, Chang TH, Chen TL, Lin CS. Complications and Mortality After Surgery in Patients with Chronic Kidney Disease: A Retrospective Cohort Study Based on a Multicenter Clinical Database. J Multidiscip Healthc 2024; 17:3535-3544. [PMID: 39070691 PMCID: PMC11283266 DOI: 10.2147/jmdh.s467613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024] Open
Abstract
Objective To evaluate the postoperative complications and mortality among patients with chronic kidney disease. Methods Biochemical measurements, diagnosis codes for CKD and comorbid conditions for surgical patients aged ≥20 years were obtained from electronic medical records of three large hospitals in Taiwan in 2009-2017. We conducted this retrospective cohort study by using propensity score-matching methods to balance the baseline characteristics between CKD and non-CKD groups. The multiple logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of risks of primary outcome (included postoperative mortality) and secondary outcome (included postoperative infectious complications and non-infectious complications) associated with CKD. Results Among 31950 eligible surgical patients, the adjusted OR of in-hospital mortality in patients with CKD was 5.49 (95% CI 3.42-8.81) compared with that in non-CKD controls. The adjusted ORs of postoperative septicemia, pneumonia and cellulitis in patients with CKD were 5.90 (95% CI 2.12-16.5), 5.39 (95% CI 1.37-21.16), and 4.42 (95% CI 1.57-12.4), respectively, when compared with the non-CKD patients. CKD was also associated with postoperative stroke (OR 2.21, 95% CI 1.47-3.31). Conclusion Patients with CKD are at increased risk of postoperative stroke, infectious complications, and mortality. Our study implicated that it is crucial to improve the levels of hemoglobin and K+ in patients with CKD before surgery. Preventive strategies should be developed to improve clinical outcomes in these populations.
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Affiliation(s)
- Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Chung Liu
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Wen Lee
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Lee WC, Chang WT, Shih JY, Wu PJ, Fang CY, Chen HC, Fang YN, Fang HY. Impact of chronic kidney disease on left atrial appendage occlusion: A meta-analysis of procedural outcomes and complications. Medicine (Baltimore) 2024; 103:e38935. [PMID: 39029071 DOI: 10.1097/md.0000000000038935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) experience atrial fibrillation more frequently. The balance of medical management for stroke prevention and bleeding events presents a challenging issue in CKD population. Left atrial appendage occlusion (LAAO) may be an effective solution for stroke prevention in patients who experience frequent bleeding with oral anticoagulants. However, the specific impact of CKD on the procedural success, complications, and outcomes of LAAO implantations remains underexplored. METHODS We conducted a search of various databases for articles published before October 31, 2023. This search yielded 7 studies, comparing outcomes between CKD and non-CKD cohorts undergoing LAAO implantation. Our analysis focused on CHA2DS2-VASc scores, average eGFR, use of oral anticoagulants, procedural success rates, procedural complications, and associated outcomes. RESULTS The meta-analysis included data from 2576 patients, with 1131 identified as having CKD. The CKD group also had higher CHA2DS2-VASc scores (4.7 ± 1.4 vs 4.0 ± 1.5; P < .001) and HAS-BLED scores (3.8 ± 1.1 vs 3.1 ± 1.0; P < .001) than the non-CKD group. CKD patients showed a nonreduction in procedural success rates and a nonsignificant increase in total complications. The risks of stroke and transient ischemic attack, major bleeding, and cardiovascular mortality were not significantly different between the 2 groups. However, a significantly lower rate of total mortality was observed in the non-CKD group (odds ratio: 0.43; 95% confidence interval, 0.32-0.60). CONCLUSION While CKD is associated with a nonsignificant decrease in procedural success and a nonsignificant increase in complication risks, the outcomes of LAAO implantation are comparably favorable between CKD and non-CKD groups. Despite similar procedural outcomes, the CKD group exhibited a higher rate of all-cause mortality.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jhih-Yuan Shih
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Jen-Ai Hospital, Taichung, Taiwan
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Sakaguchi E, Naruse H, Ishihara Y, Hattori H, Yamada A, Kawai H, Muramatsu T, Kitagawa F, Takahashi H, Ishii J, Sarai M, Yanase M, Ozaki Y, Saito K, Izawa H. Efficacy of CHA 2DS 2-VASc scores in predicting chronic kidney disease risk in patients treated in cardiac intensive care units. Heliyon 2024; 10:e32452. [PMID: 39044981 PMCID: PMC11263721 DOI: 10.1016/j.heliyon.2024.e32452] [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: 04/08/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024] Open
Abstract
The CHA2DS2 -VASc score is a vital clinical tool for evaluating thromboembolic risk in patients with atrial fibrillation (AF). This study investigated the efficacy of the CHA2DS2 -VASc score in a cohort of 737 heterogeneous patients (mean age: 63 years) receiving care in cardiac intensive care units (CICUs), with a creatinine-based estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m2 upon admission and discharge. Incident chronic kidney disease (CKD) was defined as the emergence of a new-onset eGFR<60 mL/min/1.73 m2, accompanied by a decline of >5 mL/min/1.73 m2 compared to that at discharge. The primary endpoint was the incidence of CKD, and the secondary endpoints included all-cause mortality, cardiovascular events, and progression to end-stage kidney disease. In this cohort, 210 (28 %) patients developed CKD. Multivariate analyses revealed that CHA2DS2 -VASc score was a significant independent predictor of incident CKD, regardless of the presence of AF. Integration of CHA2DS2 -VASc scores with eGFR enhanced the predictive accuracy of incident CKD, as evidenced by the improved C-index, net reclassification improvement, and integrated discrimination improvement values (all p < 0.05). Over the 12-month follow-up period, a composite endpoint was observed in 61 patients (8.3 %), with elevated CHA2DS2 -VASc scores being independently associated with this endpoint. In conclusion, CHA2DS2-VASc scores have emerged as robust predictors of both CKD incidence and adverse outcomes. Their inclusion substantially refined the 12-month risk stratification of patients with preserved renal function hospitalized in the CICUs.
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Affiliation(s)
- Eirin Sakaguchi
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroyuki Naruse
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuya Ishihara
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hidekazu Hattori
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Fumihiko Kitagawa
- Department of Cardiology, Fujita Health University Graduate School of Medicine, Okazaki Medical Center, 1 Aza Gotanda, Harisaki-cho, Okazaki, Aichi, 444-0827, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Junnichi Ishii
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masanobu Yanase
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Graduate School of Medicine, Okazaki Medical Center, 1 Aza Gotanda, Harisaki-cho, Okazaki, Aichi, 444-0827, Japan
| | - Kuniaki Saito
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Chou CL, Chiu HW, Hsu YH, Yu SMW, Liou TH, Sung LC. Impact of chronic kidney disease and end-stage renal disease on the mid-term adverse outcomes in diabetic patients with cardiovascular diseases. Sci Rep 2024; 14:15770. [PMID: 38982230 PMCID: PMC11233494 DOI: 10.1038/s41598-024-66655-0] [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: 01/21/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
The evidence for the impact of renal dysfunction in patients with diabetes mellitus (DM) and first cardiovascular diseases on mid-term adverse outcomes remain scarce. This study included the data of patients with DM having first atherosclerotic cardiovascular disease (ASCVD) or congestive heart failure (CHF) from the Taipei Medical University Clinical Research Database. A Cox proportional hazards regression model was used to assess the impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on the 1-year mortality and recurrent ASCVD/CHF outcomes. We enrolled 21,320 patients with DM hospitalized for ASCVD or CHF; of them, 18,185, 2639, and 496 were assigned to the non-CKD, CKD, and ESRD groups, respectively. After propensity score matching, compared with the non-CKD group, the CKD and ESRD groups had higher mid-term all-cause mortality (adjusted hazard ratio 1.72 [95% confidence interval 1.48-1.99] and 2.77 [2.05-3.73], respectively), cardiovascular death (1.84 [1.44-2.35] and 1.87 [1.08-3.24], respectively), and recurrent hospitalization for ASCVD (1.44 [1.24-1.68] and 2.33 [1.69-3.23], respectively) and CHF (2.08 [1.75-2.47] and 1.50 [1.04-2.17], respectively). The advancing age was associated with mortality in CKD/ESRD groups. In CKD group, male sex was associated with all-cause mortality and recurrent ASCVD risk; the diuretics usage was associated with mortality and recurrent CHF risks. Our findings suggest that CKD and ESRD are significant risk factors for mid-term adverse outcomes in patients with DM and established cardiovascular diseases. Additionally, old age, male sex and diuretics usage requires attention. Further good quality studies are needed in the future.
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Affiliation(s)
- Chu-Lin Chou
- Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Hui-Wen Chiu
- Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yung-Ho Hsu
- Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Samuel Mon-Wei Yu
- Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, USA
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chin Sung
- Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.
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Vu T, Kokubo Y, Inoue M, Yamamoto M, Mohsen A, Martin-Morales A, Inoué T, Dawadi R, Araki M. Machine Learning Approaches for Stroke Risk Prediction: Findings from the Suita Study. J Cardiovasc Dev Dis 2024; 11:207. [PMID: 39057627 PMCID: PMC11276746 DOI: 10.3390/jcdd11070207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke constitutes a significant public health concern due to its impact on mortality and morbidity. This study investigates the utility of machine learning algorithms in predicting stroke and identifying key risk factors using data from the Suita study, comprising 7389 participants and 53 variables. Initially, unsupervised k-prototype clustering categorized participants into risk clusters, while five supervised models including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosted Machine (LightGBM) were employed to predict stroke outcomes. Stroke incidence disparities among identified risk clusters using the unsupervised k-prototype clustering method are substantial, according to the findings. Supervised learning, particularly RF, was a preferable option because of the higher levels of performance metrics. The Shapley Additive Explanations (SHAP) method identified age, systolic blood pressure, hypertension, estimated glomerular filtration rate, metabolic syndrome, and blood glucose level as key predictors of stroke, aligning with findings from the unsupervised clustering approach in high-risk groups. Additionally, previously unidentified risk factors such as elbow joint thickness, fructosamine, hemoglobin, and calcium level demonstrate potential for stroke prediction. In conclusion, machine learning facilitated accurate stroke risk predictions and highlighted potential biomarkers, offering a data-driven framework for risk assessment and biomarker discovery.
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Affiliation(s)
- Thien Vu
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
- Department of Cardiac Surgery, Cardiovascular Center, Cho Ray Hospital, Ho Chi Minh City 72713, Vietnam
| | - Yoshihiro Kokubo
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Mai Inoue
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Masaki Yamamoto
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Attayeb Mohsen
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
| | - Agustin Martin-Morales
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Takao Inoué
- Faculty of Informatics, Yamato University, 2-5-1 Katayama, Suita 564-0082, Japan;
| | - Research Dawadi
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Michihiro Araki
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
- Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
- Graduate School of Science Technology and Innovation, Kobe University, 1-1 Rokkodai Nada-ku, Kobe 657-8501, Japan
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9
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Dulam V, Katta S, Nakka VP. Stroke and Distal Organ Damage: Exploring Brain-Kidney Crosstalk. Neurochem Res 2024; 49:1617-1627. [PMID: 38376748 DOI: 10.1007/s11064-024-04126-8] [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: 12/17/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
Stroke and kidney dysfunction represent significant public health challenges, yet the precise mechanisms connecting these conditions and their severe consequences remain unclear. Individuals experiencing chronic kidney disease (CKD) and acute kidney injury (AKI) are at heightened susceptibility to experiencing repeated strokes. Similarly, a reduced glomerular filtration rate is associated with an elevated risk of suffering a stroke. Prior strokes independently contribute to mortality, end-stage kidney disease, and cardiovascular complications, underscoring the pathological connection between the brain and the kidneys. In cases of AKI, various mechanisms, such as cytokine signaling, leukocyte infiltration, and oxidative stress, establish communication between the brain and the kidneys. The bidirectional relationship between stroke and kidney pathologies involves key factors such as uremic toxins, proteinuria, inflammatory responses, decreased glomerular filtration, impairment of the blood-brain barrier (BBB), oxidative stress, and metabolites produced by the gut microbiota. This review examines potential mechanisms of brain-kidney crosstalk underlying stroke and kidney diseases. It holds significance for comprehending multi-organ dysfunction associated with stroke and for formulating therapeutic strategies to address stroke-induced kidney dysfunction and the bidirectional pathological connection between the kidney and stroke.
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Affiliation(s)
- Vandana Dulam
- Department of Biochemistry, Acharya Nagarjuna University, Andhra Pradesh, 522510, India
| | - Sireesha Katta
- Department of Biochemistry, Acharya Nagarjuna University, Andhra Pradesh, 522510, India
| | - Venkata Prasuja Nakka
- Department of Biochemistry, Acharya Nagarjuna University, Andhra Pradesh, 522510, India.
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10
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Borończyk M, Kuźniak M, Borończyk A, Barański K, Hawrot-Kawecka A, Lasek-Bal A. Chronic Kidney Disease Increases Mortality and Reduces the Chance of a Favorable Outcome in Stroke Patients Treated with Mechanical Thrombectomy-Single-Center Study. J Clin Med 2024; 13:3469. [PMID: 38930001 PMCID: PMC11204577 DOI: 10.3390/jcm13123469] [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: 06/02/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Chronic kidney disease (CKD) is identified as a risk factor for the occurrence of ischemic stroke. There is substantial evidence that CKD is linked to a worse prognosis and higher mortality rates in stroke patients. This study aimed to evaluate the characteristics and factors affecting favorable outcomes and mortality in patients treated using mechanical thrombectomy (MT) for ischemic stroke, with particular emphasis on patients suffering from CKD. Methods: The retrospective study included an analysis of data from 723 patients (139; 19.4% had CKD) with ischemic stroke treated with MT between March 2019 and July 2022. Results: Patients with CKD were significantly older (median age 76.5 vs. 65.65, p < 0.001) and more often female (59.7% vs. 42.6%, p < 0.001). CKD decreased the likelihood of achieving a favorable outcome (0-2 points in modified Rankin scale; OR: 0.56, CI95%: 0.38-0.81) and increased mortality (OR: 2.59, CI95%: 1.74-3.84) on the 90th day after stroke. In addition, CKD was associated with intracranial hemorrhage (ICH) in patients who underwent posterior circulation MT (13.85% vs. 50%, p = 0.022). In patients with CKD, inter alia, higher levels of C-reactive protein (OR: 0.94, CI95%: 0.92-0.99) reduced the chance of a favorable outcome. In addition, the occurrence of ICH in patients with CKD increased mortality on the 90th day after stroke (OR: 4.18, CI95%: 1.56-11.21), which was almost twice as high as in patients without CKD (OR: 2.29, CI95%: 1.54-3.40). Conclusions: Patients suffering from CKD had a lower probability of achieving a favorable outcome and had increased mortality following MT for ischemic stroke. It is crucial to understand the variations between patients with unimpaired and impaired renal function, as this could aid in predicting the outcomes of this method.
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Affiliation(s)
- Michał Borończyk
- Students’ Scientific Association, Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.B.)
| | - Mikołaj Kuźniak
- Students’ Scientific Association, Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.B.)
| | - Agnieszka Borończyk
- Students’ Scientific Association, Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.B.)
| | - Kamil Barański
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Hawrot-Kawecka
- Department of Internal and Metabolic Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Upper-Silesian Medical Centre, Medical University of Silesia, 40-752 Katowice, Poland
| | - Anetta Lasek-Bal
- Upper-Silesian Medical Centre, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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11
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Liu C, Qiu L, Zhang Y, Chen L, Wang H, Lin H, Tao Y, Ye H. The interaction between estimated glomerular filtration rate and dietary magnesium intake and its effect on stroke prevalence: a cross-sectional study spanning 2003-2018. Front Nutr 2024; 11:1395685. [PMID: 38919391 PMCID: PMC11196627 DOI: 10.3389/fnut.2024.1395685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
Background Despite the known associations of dietary magnesium intake and estimated glomerular filtration rate (eGFR) with cardiovascular diseases, their combined effects on stroke risk remain unclear. Therefore, this study aims to explore the associations of dietary magnesium intake and eGFR with stroke risk. Methods The National Health and Nutrition Examination Survey (NHANES) data of 37,637 adult participants (≥18 years) from 2003 to 2018 was analyzed. Dietary magnesium intake was categorized as low (≤ 254 mg/day) and normal (> 254 mg/day) based on experimental data. Multiple logistic regression analyses and interaction tests were conducted to assess the associations of dietary magnesium intake and eGFR with stroke risk, with a focus on the interaction between different chronic kidney disease (CKD) stages based on eGFR levels and dietary magnesium intake. Additional analyses included multiplicative interaction analysis, restricted cubic spline analysis, and subgroup evaluations by age, sex, and ethnicity. Results Dietary magnesium intake and eGFR were inversely correlated with the risk of stroke. Participants with low dietary magnesium intake had a higher stroke risk than those with normal magnesium intake (odds ratio [OR] 1.09, 95% confidence interval [CI]: 1.03-1.42). Likewise, low eGFR was associated with an elevated stroke risk compared with normal eGFR (OR 1.56, 95% CI: 1.15-2.13). Furthermore, the two factors showed a multiplicative interaction effect on stroke risk (OR 1.05, 95% CI: 1.01-1.09). We observed a significant interaction between stage G3 CKD and low dietary magnesium intake (OR 1.05, 95% CI: 1.01-1.09), suggesting a potential association with stroke risk. However, similar associations were not observed for stages G4 and G5, possibly due to the smaller number of participants with G4 and G5 CKD. The restricted cubic spline analysis revealed a non-linear relationship between dietary magnesium intake, eGFR, and stroke risk. The interaction between magnesium deficiency and low eGFR persisted in participants aged >60 years, as well as in females, non-Hispanic Black people, and people of other races. Conclusion Dietary magnesium intake and eGFR correlate negatively with stroke prevalence. Moreover, there was an interaction between dietary magnesium intake and stroke prevalence across different CKD stages. Further large-scale prospective studies are needed to analyze the potential relationship between dietary magnesium intake, eGFR, and stroke.
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Affiliation(s)
- Chunhua Liu
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Linan Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuanyuan Zhang
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Liping Chen
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Huaqiang Wang
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Huajian Lin
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Yongjun Tao
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Haiqin Ye
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Lee KY, Lee SR, Choi EK, Choi J, Ahn HJ, Kwon S, Kim B, Han KD, Oh S, Lip GYH. Association between changes in renal function and clinical outcomes in anticoagulated atrial fibrillation patients with marginal renal function. A nationwide observational cohort study. Front Cardiovasc Med 2024; 11:1423336. [PMID: 38903967 PMCID: PMC11188773 DOI: 10.3389/fcvm.2024.1423336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
Background Renal function is one of the crucial components for determining the dose and type of oral anticoagulants in atrial fibrillation (AF) patients, and is also closely associated with the risks of stroke and bleeding. This study aimed to assess renal function changes and their impact on clinical outcomes in anticoagulated AF patients with marginal renal function. Methods From a Korean claims database, patients with AF on anticoagulants and a baseline eGFR of 45 to <60 ml/min/1.73 m2 were studied. Patients were grouped by changes in renal function over two years-maintained, improved (eGFR >60 ml/min/1.73 m2), or worsened (eGFR <45 ml/min/1.73 m2)-the study analyzed outcomes including ischemic stroke, major bleeding, end-stage renal disease (ESRD), all-cause death, and a composite of clinical outcomes. Results A total of 5,126 patients were included in the study: 2,170 (42.3%) in the maintained group, 2,276 (44.4%) in the improved group, and 680 (13.1%) in the group with worsened renal function. The worsened group was older and had more prevalent comorbidities than other groups. After multivariable adjustment, the worsened group was associated with significantly higher risks of major bleeding (adjusted hazard ratio, 95% confidence interval; 1.46, 1.03-2.07, p = 0.035), ESRD (1.49, 1.24-1.80, p < 0.001), all-cause death (9.29, 4.92-17.6, p < 0.001), and the composite outcome (1.57, 1.36-1.83, p < 0.001). Conclusions In anticoagulated AF patients with marginal renal function, a substantial proportion of patients experienced renal function decline below eGFR 45 ml/min/1.73 m2 within 2 years. Renal function decline was associated with higher risks of major bleeding, ESRD, all-cause death, and the composite outcome compared to those who maintained their baseline renal function.
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Affiliation(s)
- Kyung-Yeon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bongseong Kim
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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13
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Chertow GM, Correa-Rotter R, Eckardt KU, Kanda E, Karasik A, Li G, Christiansen CF, Stafylas P, Holt SG, Hagen EC, Garcia Sanchez JJ, Barone S, Cabrera C, Nolan S, Coker T, Webber L, Retat L. Projecting the clinical burden of chronic kidney disease at the patient level ( Inside CKD): a microsimulation modelling study. EClinicalMedicine 2024; 72:102614. [PMID: 39010981 PMCID: PMC11247147 DOI: 10.1016/j.eclinm.2024.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 07/17/2024] Open
Abstract
Background Chronic kidney disease (CKD) is a global concern that presents significant challenges for disease management. Several factors drive CKD prevalence, including primary risk factors, such as type 2 diabetes and hypertension, and an ageing population. Inside CKD is an international initiative that aims to raise awareness of the substantial burden incurred by CKD. Methods Using a peer-reviewed microsimulation method, the clinical burden of CKD was estimated from 2022 to 2027. Demographic data from the Americas, Europe, and Asia-Pacific/Middle East were used to generate virtual populations and to project the prevalence of CKD, kidney replacement therapy, associated cardiovascular complications, comorbid conditions, and all-cause mortality in the CKD population over the modelled time frame. Findings Across the 31 participating countries/regions, the total prevalence of CKD was projected to rise to 436.6 million cases by 2027 (an increase of 5.8% from 2022), with most cases (∼80%) undiagnosed. Inside CKD projected a mean of 8859 cases of heart failure, 10,244 of myocardial infarction, and 7797 of stroke per 100,000 patients with CKD by 2027. Interpretation The clinical impact of CKD is substantial and likely to increase; the high prevalence of undiagnosed cases and associated complications may benefit from the implementation of health policy interventions that promote screening, earlier diagnosis, and interventions to improve outcomes. Funding AstraZeneca.
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Affiliation(s)
- Glenn M Chertow
- Stanford University School of Medicine, Stanford Palo Alto, CA 94305, USA
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan
| | - Avraham Karasik
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Guisen Li
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu 610072, China
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
| | - Panos Stafylas
- HealThink, THERMI GROUP, Steliou Kazantzidi 47 str., Building 1, PC 57 001, PO Box 8121, Thessaloniki, Greece
| | - Stephen G Holt
- SEHA Kidney Care, SKC Central, Abu Dhabi Health Services Co., Al Himam St, Al Mafraq, Abu Dhabi, United Arab Emirates
| | - Ernst C Hagen
- Meander Medical Center, Maatweg 3, Amersfoort 3813 TZ, Netherlands
| | - Juan Jose Garcia Sanchez
- Global Health Economics, BioPharmaceuticals, AstraZeneca, Academy House, 136 Hills Road, Cambridge CB2 8PA, UK
| | - Salvatore Barone
- Global Medical Affairs, BioPharmaceuticals, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Claudia Cabrera
- Real World Science and Analytics, BioPharmaceuticals Medical, AstraZeneca, Gothenburg SE-431 83, Sweden
| | - Stephen Nolan
- Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge CB2 0AA, UK
| | | | | | - Lise Retat
- HealthLumen Limited, London EC3N 2PJ, UK
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14
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Chin K, Jiang H, Steinberg BE, Goldenberg NM, Desjardins JF, Kabir G, Liu E, Vanama R, Baker AJ, Deschamps A, Simpson JA, Maynes JT, Vinogradov SA, Connelly KA, Mazer CD, Hare GMT. Bilateral nephrectomy impairs cardiovascular function and cerebral perfusion in a rat model of acute hemodilutional anemia. J Appl Physiol (1985) 2024; 136:1245-1259. [PMID: 38385183 DOI: 10.1152/japplphysiol.00858.2023] [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: 11/28/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
Anemia and renal failure are independent risk factors for perioperative stroke, prompting us to assess the combined impact of acute hemodilutional anemia and bilateral nephrectomy (2Nx) on microvascular brain Po2 (PBro2) in a rat model. Changes in PBro2 (phosphorescence quenching) and cardiac output (CO, echocardiography) were measured in different groups of anesthetized Sprague-Dawley rats (1.5% isoflurane, n = 5-8/group) randomized to Sham 2Nx or 2Nx and subsequently exposed to acute hemodilutional anemia (50% estimated blood volume exchange with 6% hydroxyethyl starch) or time-based controls (no hemodilution). Outcomes were assessed by ANOVA with significance assigned at P < 0.05. At baseline, 2Nx rats demonstrated reduced CO (49.9 ± 9.4 vs. 66.3 ± 19.3 mL/min; P = 0.014) and PBro2 (21.1 ± 2.9 vs. 32.4 ± 3.1 mmHg; P < 0.001) relative to Sham 2Nx rats. Following hemodilution, 2Nx rats demonstrated a further decrease in PBro2 (15.0 ± 6.3 mmHg, P = 0.022). Hemodiluted 2Nx rats did not demonstrate a comparable increase in CO after hemodilution compared with Sham 2Nx (74.8 ± 22.4 vs. 108.9 ± 18.8 mL/min, P = 0.003) that likely contributed to the observed reduction in PBro2. This impaired CO response was associated with reduced fractional shortening (33 ± 9 vs. 51 ± 5%) and increased left ventricular end-systolic volume (156 ± 51 vs. 72 ± 15 µL, P < 0.001) suggestive of systolic dysfunction. By contrast, hemodiluted Sham 2Nx animals demonstrated a robust increase in CO and preserved PBro2. These data support the hypothesis that the kidney plays a central role in maintaining cerebral perfusion and initiating the adaptive increase in CO required to optimize PBro2 during acute anemia.NEW & NOTEWORTHY This study has demonstrated that bilateral nephrectomy acutely impaired cardiac output (CO) and microvascular brain Po2 (PBro2), at baseline. Following acute hemodilution, nephrectomy prevented the adaptive increase in CO associated with acute hemodilution leading to a further reduction in PBro2, accentuating the degree of cerebral tissue hypoxia. These data support a role for the kidney in maintaining PBro2 and initiating the increase in CO that optimized brain perfusion during acute anemia.
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Affiliation(s)
- Kyle Chin
- Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Helen Jiang
- Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin E Steinberg
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Neil M Goldenberg
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jean-Francois Desjardins
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Golam Kabir
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Liu
- Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ramesh Vanama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Baker
- Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Alain Deschamps
- Institut de Cardiologie de Montréal, Université de Montréal, Montreal Quebec, Canada
| | - Jeremy A Simpson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
- IMPART investigator team Canada (https://impart.team/), Saint John, New Brunswick, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Molecular Medicine, Hospital for Sick Children's Research Institute, Toronto, Ontario, Canada
| | - Sergei A Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Gregory M T Hare
- Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- IMPART investigator team Canada (https://impart.team/), Saint John, New Brunswick, Canada
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15
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Bakris G, Lin P(P, Xu C, Chen C, Ashton V, Singhal M. Prediction of cardiovascular and renal risk among patients with apparent treatment-resistant hypertension in the United States using machine learning methods. J Clin Hypertens (Greenwich) 2024; 26:500-513. [PMID: 38523465 PMCID: PMC11088433 DOI: 10.1111/jch.14791] [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: 09/29/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Abstract
Apparent treatment-resistant hypertension (aTRH), defined as blood pressure (BP) that remains uncontrolled despite unconfirmed concurrent treatment with three antihypertensives, is associated with an increased risk of developing cardiovascular and renal complications compared with controlled hypertension. We aimed to identify the characteristics of aTRH patients with an elevated risk of major adverse cardiovascular events plus (MACE+; defined as stroke, myocardial infarction, or heart failure hospitalization) and end stage renal disease (ESRD). This retrospective cohort study included aTRH patients (BP ≥140/90 mmHg and taking ≥3 antihypertensives) from the United States-based Optum® de-identified Electronic Health Record dataset and used machine learning models to identify risk factors of MACE+ or ESRD. Patients had claims for ≥3 antihypertensive classes within 30 days between January 1, 2015 and June 30, 2021, and two office BP measures recorded 1-90 days apart within 30 days to 11 months after the index regimen date. Of a total 18 797 070 patients identified with any hypertension, 71 100 patients had aTRH. During the study period (mean 25.5 months), 4944 (7.0%) patients had a MACE+ and 2403 (3.4%) developed ESRD. In total, 22 risk factors were included in the MACE+ model and 16 in the ESRD model, and most were significantly associated with study outcomes. The risk factors with the largest impact on MACE+ risk were congestive heart failure, stages 4 and 5 chronic kidney disease (CKD), age ≥80 years, and living in the Southern region of the United States. The risk factors with the largest impact on ESRD risk, other than pre-existing CKD, were anemia, congestive heart failure, and type 2 diabetes. The overall study cohort had a 5-year predicted MACE+ risk of 13.4%; this risk was increased in those in the top 50% and 25% high-risk groups (21.2% and 29.5%, respectively). The overall study cohort had a predicted 5-year risk of ESRD of 6.8%, which was increased in the top 50% and 25% high-risk groups (10.9% and 17.1%, respectively). We conclude that risk models developed in our study can reliably identify patients with aTRH at risk of MACE+ and ESRD based on information available in electronic health records; such models may be used to identify aTRH patients at high risk of adverse outcomes who may benefit from novel treatment interventions.
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Affiliation(s)
| | | | - Chang Xu
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Cindy Chen
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | | | - Mukul Singhal
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
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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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Bobot M, Hak JF, Casolla B, Dehondt JD, Burtey S, Doche E, Suissa L. Acute and Chronic Kidney Dysfunction and Prognosis following Thrombectomy for Ischemic Stroke. Am J Nephrol 2024; 55:287-297. [PMID: 38499002 DOI: 10.1159/000536493] [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: 11/24/2023] [Accepted: 01/10/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) have an increased risk of stroke, and CKD seems associated with worse outcome after a stroke. The main objective of our study RISOTTO was to evaluate the influence of CKD and acute kidney injury (AKI) on the clinical outcome and mortality of ischemic stroke patients after thrombolysis and/or thrombectomy. METHODS This multicenter cohort study included patients in the acute phase of ischemic stroke due to large artery occlusion managed by thrombectomy. Functional outcome at 3 months was assessed by the modified Rankin Scale (mRS). RESULTS 280 patients were included in the analysis. Fifty-nine patients (22.6%) had CKD. At 3 months, CKD was associated with similar functional prognosis (mRS 3-6: 50.0% vs. 41.7%, p = 0.262) but higher mortality (24.2% versus 9.5%, p = 0.004). In univariate analysis, patients with CKD had a higher burden of white matter hyperintensities (Fazekas score: 1.7 ± 0.8 vs. 1.0 ± 0.8, p = 0.002), lower initial infarct volume with equivalent severity, and lower recanalization success (86.4% vs. 97.0%, p = 0.008) compared to non-CKD patients. Forty-seven patients (20.0%) developed AKI. AKI was associated with poorer 3-month functional outcome (mRS 3-6: 63.8% vs. 49.0%, p = 0.002) and mortality (23.4% versus 7.7%, p = 0.002). In multivariate analysis, AKI appeared as an independent risk factor for poor functional outcome (mRS 3-6: adjOR 2.79 [1.11-7.02], p = 0.029) and mortality (adjOR 2.52 [1.03-6.18], p = 0.043) at 3 months, while CKD was not independently associated with 3-month mortality and poor neurological outcome. CONCLUSIONS AKI is independently associated with poorer functional outcome and increased mortality at 3 months. CKD was not an independent risk factor for 3-month mortality or poor functional prognosis.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- CERIMED, Aix Marseille Univ, Marseille, France
| | - Jean-François Hak
- CERIMED, Aix Marseille Univ, Marseille, France
- Neuroradiology Department, CHU Timone, AP-HM, Marseille, France
- LIIE, CERIMED, Aix-Marseille Université, Marseille, France
| | - Barbara Casolla
- Stroke Unit, UR2CA-URRIS Neurology, Nice Cote d'Azur University, Nice, France
| | | | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Emilie Doche
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- Stroke Center, Hôpital de la Timone, AP-HM, Marseille, France
| | - Laurent Suissa
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- Stroke Center, Hôpital de la Timone, AP-HM, Marseille, France
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18
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Bothe T, Fietz AK, Schaeffner E, Douros A, Pöhlmann A, Mielke N, Villain C, Barghouth MH, Wenning V, Ebert N. Diagnostic Validity of Chronic Kidney Disease in Health Claims Data Over Time: Results from a Cohort of Community-Dwelling Older Adults in Germany. Clin Epidemiol 2024; 16:143-154. [PMID: 38410416 PMCID: PMC10895982 DOI: 10.2147/clep.s438096] [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: 09/14/2023] [Accepted: 12/15/2023] [Indexed: 02/28/2024] Open
Abstract
Purpose The validity of ICD-10 diagnostic codes for chronic kidney disease (CKD) in health claims data has not been sufficiently studied in the general population and over time. Patients and Methods We used data from the Berlin Initiative Study (BIS), a prospective longitudinal cohort of community-dwelling individuals aged ≥70 years in Berlin, Germany. With estimated glomerular filtration rate (eGFR) as reference, we assessed the diagnostic validity (sensitivity, specificity, positive [PPV], and negative predictive values [NPV]) of different claims-based ICD-10 codes for CKD stages G3-5 (eGFR <60mL/min/1.73m²: ICD-10 N18.x-N19), G3 (eGFR 30-<60mL/min/1.73m²: N18.3), and G4-5 (eGFR <30mL/min/1.73m²: N18.4-5). We analysed trends over five study visits (2009-2019). Results We included data of 2068 participants at baseline (2009-2011) and 870 at follow-up 4 (2018-2019), of whom 784 (38.9%) and 440 (50.6%) had CKD G3-5, respectively. At baseline, sensitivity for CKD in claims data ranged from 0.25 (95%-confidence interval [CI] 0.22-0.28) to 0.51 (95%-CI 0.48-0.55) for G3-5, depending on the included ICD-10 codes, 0.20 (95%-CI 0.18-0.24) for G3, and 0.36 (95%-CI 0.25-0.49) for G4-5. Over the course of 10 years, sensitivity increased by 0.17 to 0.29 in all groups. Specificity, PPVs, and NPVs remained mostly stable over time and ranged from 0.82-0.99, 0.47-0.89, and 0.66-0.98 across all study visits, respectively. Conclusion German claims data showed overall agreeable performance in identifying older adults with CKD, while differentiation between stages was limited. Our results suggest increasing sensitivity over time possibly attributable to improved CKD diagnosis and awareness.
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Affiliation(s)
- Tim Bothe
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonios Douros
- Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Anna Pöhlmann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Mielke
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cédric Villain
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Normandie Univ UNICAEN, INSERM U1075 COMETE, service de Gériatrie, CHU de Caen, Caen, France
| | | | | | - Natalie Ebert
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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López-Tejero S, Antúnez-Muiños P, Fraile-Gómez P, Sousa GBD, Rodríguez-Collado J, Herrero-Garibi J, Blanco-Fernández F, Diego-Nieto A, Delgado-Lapeira GC, Del Villar-Moro MCP, Martín-Moreiras J, Sánchez-Fernández PL, Cruz-González I. Left atrial appendage occlusion in patients suffering from advanced chronic kidney disease (stage 4 and 5). Long-term follow-up. Catheter Cardiovasc Interv 2024; 103:499-510. [PMID: 38168895 DOI: 10.1002/ccd.30946] [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: 10/19/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION AND OBJECTIVES Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD. METHODS Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m2 ) who underwent LAAO between 2009 and May 2022. RESULTS Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA2 DS2 -VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate: at 1-year (HR: 1.22, IC-95%: 0.14-10.42, p = 0.861); at 5-years (HR: 0.60, IC-95%: 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR: 1.34, IC-95%: 0.63-2.88, p = 0.464) or at 5-years follow-up (HR: 1.30, IC-95%: 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR: 1.84, IC-95%: 1.18-2.87, p = 0.012). CONCLUSIONS LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.
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Affiliation(s)
- Sergio López-Tejero
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Pablo Antúnez-Muiños
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Pilar Fraile-Gómez
- Department of Nephrology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
| | - Gilles Barreira-de Sousa
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Javier Rodríguez-Collado
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Jesús Herrero-Garibi
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Fabián Blanco-Fernández
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Alejandro Diego-Nieto
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | | | - M Candelas Pérez Del Villar-Moro
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Javier Martín-Moreiras
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Pedro L Sánchez-Fernández
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
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20
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Rajesh K, Spring KJ, Beran RG, Bhaskar SMM. Chronic kidney disease prevalence and clinical outcomes in anterior circulation acute ischemic stroke patients with reperfusion therapy: A meta-analysis. Nephrology (Carlton) 2024; 29:21-33. [PMID: 37964507 DOI: 10.1111/nep.14251] [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: 08/23/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
AIM Chronic Kidney Disease (CKD) is a common comorbidity among acute ischaemic stroke (AIS) patients undergoing reperfusion therapies, including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Acknowledging CKD's prevalence in this cohort and understanding its influence on outcomes is crucial for prognosis and optimizing care. This study aims to determine the prevalence of CKD among anterior circulation AIS (acAIS) patients undergoing reperfusion therapies and to analyse the role of CKD in mediating outcomes. METHODS A random-effects meta-analysis was conducted to pool and examine prevalence data. A total of 263 633 patients were included in the meta-analysis. The study assessed CKD's association with functional outcomes, symptomatic intracranial haemorrhage (sICH) and mortality. RESULTS The overall pooled prevalence of CKD among acAIS ranged from 30% to 56% in IVT-treated patients and 16%-42% for EVT-treated patients. CKD was associated with increased odds of unfavourable functional outcome at 90 days in both IVT (OR 1.837; 95% CI: [1.599; 2.110]; p < .001) and EVT (OR 1.804; 95% CI: [1.525; 2.133]; p < .001) groups. In IVT-treated patients, CKD was associated with increased odds of 30-day mortality (OR 6.211; 95% CI: [1.105; 34.909]; p = .038). CKD in IVT-treated patients exhibited increased odds of sICH, albeit statistically non-significant (OR 1.595; 95% CI: [0.567; 3.275]). CONCLUSIONS The high prevalence of CKD and its significant impact on outcomes in acAIS patients treated with reperfusion therapies underscore its clinical significance. This insight can guide personalised care strategies and potentially improve the prognosis in the management of acAIS.
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Affiliation(s)
- Kruthajn Rajesh
- Global Health Neurology Lab, Sydney, New South Wales, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
| | - Kevin J Spring
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Medical Oncology Group, Liverpool Clinical School, Ingham Institute for Applied Medical Research and Western Sydney University (WSU), Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Roy G Beran
- Global Health Neurology Lab, Sydney, New South Wales, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Griffith Health, School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, New South Wales, Australia
| | - Sonu M M Bhaskar
- Global Health Neurology Lab, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, New South Wales, Australia
- Department of Neurology, National Cerebral and Cardiovascular Centre (NCVC), Suita, Osaka, Japan
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21
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Zhang Y, Pan Y, Cai X, Jing J, Yan H, Wang S, Meng X, Mei L, Zhang Y, Li S, Wei T, Zhou Y, Wang Y. Association between Urine Albumin-to-creatinine Ratio and Intracranial Atherosclerotic Plaque in Chinese Adults - Results from the PRECISE Study. J Atheroscler Thromb 2023; 30:1828-1837. [PMID: 37197951 DOI: 10.5551/jat.64156] [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] [Indexed: 05/19/2023] Open
Abstract
AIMS Intracranial plaque may cause stroke in the absence of luminal stenosis. Although urine albumin-to-creatinine ratio (ACR) has been proved an established risk factor for cardiovascular disease, stroke and carotid atherosclerosis, little is known on the relationship between urine ACR and intracranial plaque. METHODS Subjects with history of stroke or coronary heart disease (CHD) were excluded in the PRECISE study. The intracranial plaque was assessed by vessel wall magnetic resonance imaging (MRI). Subjects were stratified according to ACR tertiles. Logistic regression and ordinal regression were performed to analyze the association between ACR and the presence of intracranial plaque or sum of the stenosis score for each artery. RESULTS 2962 individuals were included with the mean age of 61.0±6.6 years. The median ACR was 11.7mg/g (interquartile range 7.0-22.0 mg/g), and the mean estimated glomerular filtration rate (eGFR) based on combination of creatinine and cystatin C was 88.5±14.8 ml/min·1.73m2. 495 (16.7%) participants had intracranial plaque. The highest ACR tertile with ACR >16.00mg/g was independently associated with the presence of intracranial plaque (OR 1.38, 95% CI: 1.05-1.82, p=0.02) and the odds of higher intracranial plaque burden (common OR 1.39, 95% CI: 1.05-1.83, p=0.02) after adjustment of confounding factors. No significant association was observed between eGFR and intracranial plaque presence or intracranial plaque burden. CONCLUSIONS Among a low-risk community-dwelling population without prior stroke or CHD in China, ACR was independently associated with intracranial plaque presence and plaque burden measured by vessel wall MRI.
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Affiliation(s)
- Yin Zhang
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine
| | - Jing Jing
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Hongyi Yan
- China National Clinical Research Center for Neurology Disease
| | - Suying Wang
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Xia Meng
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Yanli Zhang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences
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Chen X, Wang J, Lin Y, Yao K, Xie Y, Zhou T. Cardiovascular outcomes and safety of SGLT2 inhibitors in chronic kidney disease patients. Front Endocrinol (Lausanne) 2023; 14:1236404. [PMID: 38047108 PMCID: PMC10690412 DOI: 10.3389/fendo.2023.1236404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023] Open
Abstract
Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors provide cardiovascular protection for patients with heart failure (HF) and type 2 diabetes mellitus (T2DM). However, there is little evidence of their application in patients with chronic kidney disease (CKD). Furthermore, there are inconsistent results from studies on their uses. Therefore, to explore the cardiovascular protective effect of SGLT2 inhibitors in the CKD patient population, we conducted a systematic review and meta-analysis to evaluate the cardiovascular effectiveness and safety of SGLT2 inhibitors in this patient population. Method We searched the PubMed® (National Library of Medicine, Bethesda, MD, USA) and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases for randomized controlled trials (RCTs) of SGLT2 inhibitors in CKD patients and built the database starting in January 2023. In accordance with our inclusion and exclusion criteria, the literature was screened, the quality of the literature was evaluated, and the data were extracted. RevMan 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) and Stata® 17.0 (StataCorp LP, College Station, TX, USA) were used for the statistical analyses. Hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs) were used for the analysis of the outcome indicators. Results Thirteen RCTs were included. In CKD patients, SGLT2 inhibitors reduced the risk of cardiovascular death (CVD) or hospitalization for heart failure (HHF) by 28%, CVD by 16%. and HHF by 35%. They also reduced the risk of all-cause death by 14% without increasing the risk of serious adverse effects (SAEs) and urinary tract infections (UTIs). However, they increased the risk of reproductive tract infections (RTIs). Conclusion SGLT2 inhibitors have a cardiovascular protective effect on patients with CKD, which in turn can significantly reduce the risk of CVD, HHF, and all-cause death without increasing the risk of SAEs and UTIs but increasing the risk of RTIs.
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Affiliation(s)
| | | | | | | | | | - Tianbiao Zhou
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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23
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Kelly DM, Georgakis MK, Franceschini N, Blacker D, Viswanathan A, Anderson CD. Interplay Between Chronic Kidney Disease, Hypertension, and Stroke: Insights From a Multivariable Mendelian Randomization Analysis. Neurology 2023; 101:e1960-e1969. [PMID: 37775316 PMCID: PMC10662984 DOI: 10.1212/wnl.0000000000207852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) increases the risk of stroke, but the extent through which this association is mediated by hypertension is unknown. We leveraged large-scale genetic data to explore causal relationships between CKD, hypertension, and cerebrovascular disease phenotypes. METHODS We used data from genome-wide association studies of European ancestry to identify genetic proxies for kidney function (CKD diagnosis, estimated glomerular filtration rate [eGFR], and urinary albumin-to-creatinine ratio [UACR]), systolic blood pressure (SBP), and cerebrovascular disease (ischemic stroke and its subtypes and intracerebral hemorrhage). We then conducted univariable, multivariable, and mediation Mendelian randomization (MR) analyses to investigate the effect of kidney function on stroke risk and the proportion of this effect mediated through hypertension. RESULTS Univariable MR revealed associations between genetically determined lower eGFR and risk of all stroke (odds ratio [OR] per 1-log decrement in eGFR, 1.77; 95% CI 1.31-2.40; p < 0.001), ischemic stroke (OR 1.81; 95% CI 1.31-2.51; p < 0.001), and most strongly with large artery stroke (LAS) (OR 3.00; 95% CI 1.33-6.75; p = 0.008). These associations remained significant in the multivariable MR analysis, controlling for SBP (OR 1.98; 95% CI 1.39-2.82; p < 0.001 for all stroke; OR 2.16; 95% CI 1.48-3.17; p < 0.001 for ischemic stroke; OR 4.35; 95% CI 1.84-10.27; p = 0.001 for LAS), with only a small proportion of the total effects mediated by SBP (6.5% [0.7%-16.8%], 6.6% [0.8%-18.3%], and 7.2% [0.5%-24.8%], respectively). Total, direct and indirect effect estimates were similar across a number of sensitivity analyses (weighted median, MR-Egger regression). DISCUSSION Our results demonstrate an independent causal effect of impaired kidney function, as assessed by decreased eGFR, on stroke risk, particularly LAS, even when controlled for SBP. Targeted prevention of kidney disease could lower atherosclerotic stroke risk independent of hypertension.
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Affiliation(s)
- Dearbhla M Kelly
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.
| | - Marios K Georgakis
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Nora Franceschini
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Deborah Blacker
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Anand Viswanathan
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Christopher D Anderson
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
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Liao J, Xiao F, Yang L, Wei Y, Song C, Li J, Yu S, Lu Y, Zhang J, Dai L, Liang W, Li T, Xiong Z, Wu Y, Jardine MJ, Carrero JJ, Shan Y, Huang X. Cystatin C-based estimated glomerular filtration rate and risk of stroke in the general population: a prospective cohort study. Clin Kidney J 2023; 16:2059-2071. [PMID: 37915909 PMCID: PMC10616444 DOI: 10.1093/ckj/sfad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Indexed: 11/03/2023] Open
Abstract
Background Previous results on the association between the estimated glomerular filtration rate (eGFR) and stroke are mixed. Most studies derived the eGFR from serum creatinine, which is affected by non-kidney determinants and thus has possibly biased the association with stroke risk. Methods In this cohort study, we included 429 566 UK Biobank participants (94.5% white, 54% women, age 56 ± 8 years) free of stroke at enrollment. The eGFRcys and eGFRcr were calculated with serum cystatin C and creatinine, respectively. Outcomes of interest were risk of total stroke and subtypes. We investigated the linear and nonlinear associations using Cox proportional hazards models and restricted cubic splines, corrected for regression dilution bias. Results During an average follow-up of 10.11 years, 4427 incident strokes occurred, among which 3447 were ischemic and 1163 were hemorrhagic. After adjustment for confounders, the regression dilution-corrected hazard ratios (95% confidence intervals) for every 10 mL/min/1.73 m2 decrement in eGFRcys were 1.10 (1.05-1.14) for total stroke and 1.11 (1.08-1.15) for ischemic stroke. A similar pattern was observed with eGFRcr, although the association was weaker. When either type of eGFR was below 75 mL/min/1.73 m2, the risks of total and ischemic stroke increased exponentially as eGFR decreased. A U-shaped relationship was witnessed if eGFRcr was used instead. There was a null association between eGFR and hemorrhagic stroke. Conclusions The risks of total stroke and ischemic stroke increased exponentially when the eGFRcys fell below 75 mL/min/1.73 m2.
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Affiliation(s)
- Jinlan Liao
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Fei Xiao
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Liuqiao Yang
- BGI-Shenzhen, Shenzhen, Guangdong Province, China
| | - Yanling Wei
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Congying Song
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Jing Li
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Sike Yu
- BGI-Shenzhen, Shenzhen, Guangdong Province, China
| | - Yueqi Lu
- BGI-Shenzhen, Shenzhen, Guangdong Province, China
| | - Jingwen Zhang
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Liang Dai
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Wei Liang
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Tao Li
- BGI-Shenzhen, Shenzhen, Guangdong Province, China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University, Beijing, China
| | - Meg J Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Department of Medicine, Stanford Centre for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm 182 88, Sweden
| | - Ying Shan
- BGI-Shenzhen, Shenzhen, Guangdong Province, China
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
| | - Xiaoyan Huang
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong Province, China
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25
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Mubaraki AA, Alotaibi WD, Sibyani AK, Alrbaiai GT, Almalki HS, Atallah HM, Basfar AS, Alqaedi A, Althobaiti HA, Algethami MM, Althobaiti YA. Prevalence of stroke among patients with chronic kidney disease, Taif, Saudi Arabia. Saudi Med J 2023; 44:1139-1144. [PMID: 37926452 PMCID: PMC10712769 DOI: 10.15537/smj.2023.44.11.20230206] [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: 09/02/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence of stroke among chronic kidney disease (CKD) patients in Taif, Saudi Arabia. METHODS A multicentric retrospective study was carried out from May 2021 to August 2022 on 4 dialysis centers in Taif, Saudi Arabia. With a total of 1857 CKD patients (aged ≥18 years old) participated in this study. Data were collected by reviewing patients' files. RESULTS Approximately 98.3% of the participants had severely decreased glomerular filtration rate. Approximately 49.1% of them were on dialysis; the majority of them (87.2%) underwent hemodialysis. The prevalence of stroke in these CKD patients was 8.3%. Ischemic stroke was the most frequently reported issue (81.2%). Ischemic stroke was comparatively more frequently observed in peritoneal dialysis patients (12.1%); whereas hemorrhagic stroke was more on hemodialysis patients with statistically significant association (p=0.029). However, there was no significant association between the prevalence of stroke and stages of CKD. CONCLUSION The prevalence of stroke in our cohort was 8.3%, and the majority of cases were ischemic strokes. Furthermore, ischemic strokes were more frequent in peritoneal dialysis patients, whereas hemorrhagic strokes occurred more frequently in hemodialysis patients with a statistically significant association.
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Affiliation(s)
- Adnan A. Mubaraki
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Waad D. Alotaibi
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Afnan K. Sibyani
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Ghaida T. Alrbaiai
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Haneen S. Almalki
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Hashim M. Atallah
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah S. Basfar
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Asrar Alqaedi
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Hisham A. Althobaiti
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed M. Algethami
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
| | - Youssef A. Althobaiti
- From the Department of Medicine (Mubaraki); from the College of Medicine (Atallah, Basfar), Taif University, from the Department of Internal Medicine (Alotaibi), King Abdulaziz Specialist Hospital; from the Department of Medicine (Y. A. Althobaiti), King Abdulaziz Specialist Hospital, from the Department of Nephrology (Alqaedi), Taif Children Hospital, from the Department of Medicine (H. A. Althobaiti), King Faisal Medical Complex, from the Department of Medicine (Algethami), Alhada Armed Forces Hospital, Taif, from the Department of Neurology (Sibyani), National Guard Health Affairs, from the Department of Neurology (Alrbaiai), King Abdullah Medical Complex, Directorate of Health Affairs, Jeddah, and from the Department of Emergency Medicine (Almalki), Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia.
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26
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Lin H, Chang Y, Zhou H, Li J, Zhou C, Huo X. Early results of frozen elephant trunk in acute type-A dissection in 1445 patients. Int J Cardiol 2023; 389:131213. [PMID: 37499947 DOI: 10.1016/j.ijcard.2023.131213] [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: 02/14/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND We aimed to briefly describe the use of total arch replacement with frozen elephant trunk in our center's 12-year treatment of acute type A dissection and the early postoperative results. We summarized the practical experience of this procedure in our center and performed regression analyses to find the independent risk factors for major complications. METHODS Consecutive patients with acute type A dissection having surgical total arch replacement with the implantation of a frozen elephant trunk were collected from January 2010 to December 2021 and were included in the analysis. For each major operation-related complication, independent risk factors were identified using both univariate and multivariate regression models. RESULTS In our institution, the total arch replacement with frozen elephant trunk procedure is used more frequently each year and makes up 70% of the surgical procedures for acute type A dissection. The overall postoperative mortality rate was 6.2%, which declined as the techniques (including surgical procedures, organ perfusion protection etc.) improved. Other complications include: 11.7% for continuous renal replacement therapy, 5.7% for stroke, 17.8% for ICU stay longer than 7 days, 10.9% for prolonged mechanical ventilation, and so on. According to regression analysis, different major complications had different independent risk factors. Several factors, such as advanced age, impaired renal function, and extended cardiopulmonary bypass time, were found to be implicated in nearly all of the complications. CONCLUSION Total arch replacement plus frozen elephant trunk strategy is a safe surgical method for extensive acute type A dissection. Some factors, such as advanced age, impaired renal function, and prolonged cardiopulmonary bypass time, might be associated with poor prognosis.
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Affiliation(s)
- Hongyuan Lin
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Chang
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Hongyan Zhou
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenghui Zhou
- Department of anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoning Huo
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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27
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Hahn K, Lamparter M. Prescription of DOACs in Patients with Atrial Fibrillation at Different Stages of Renal Insufficiency. Adv Ther 2023; 40:4264-4281. [PMID: 37594666 PMCID: PMC10499752 DOI: 10.1007/s12325-023-02544-8] [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: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 08/19/2023]
Abstract
Atrial fibrillation (AF) and renal insufficiency often coexist and are increasingly prevalent with advancing age. Both the risk of thromboembolic events and bleeding propensity are higher in patients with AF and impaired renal function versus those with good renal health. Direct oral anticoagulants (DOACs) are being increasingly preferred over vitamin K antagonists (VKAs) in the treatment of patients with AF and impaired renal function as VKAs may accelerate progression of chronic kidney disease. DOACs, however, are eliminated by the kidneys to varying degrees, and their dosages must be adapted in accordance with renal function. Since creatinine clearance (CrCl) monitoring is recommended in patients with AF receiving DOAC therapy, CrCl must be routinely monitored in patients at the start and during the course of anticoagulation to avoid deviation from Summary of Product Characteristics dosage specifications. This review article provides an overview of current knowledge on the selection and dose of DOACs including apixaban, dabigatran, edoxaban and rivaroxaban in AF patients at different stages of renal insufficiency, with a special focus on elderly patients with comorbidities and receiving multiple medications. The groups discussed in this review include patients with varying levels of CrCl including hyperfiltration or CrCl > 90 ml/min, CrCl < 90-50 ml/min, CrCl < 50-30 ml/min, CrCl < 30-15 ml/min and end-stage renal disease or on dialysis.
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Affiliation(s)
- Kai Hahn
- Praxis für Nieren- und Hochdruckkrankheiten Dr. Hahn, Märkische Straße 237, 44141, Dortmund, Germany.
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Nash PS, Best JG, Ambler G, Wilson D, Banerjee G, Hostettler IC, Seiffge D, Cohen H, Yousry TA, Salman RAS, Lip GYH, Brown MM, Muir KW, Houlden H, Jäger HR, Werring DJ. Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study. J Neurol Sci 2023; 452:120743. [PMID: 37531792 DOI: 10.1016/j.jns.2023.120743] [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: 05/04/2023] [Revised: 07/02/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Intracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised. METHODS Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0-3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR<60). We assessed functional outcome at 6-month follow-up using the modified Rankin scale. RESULTS 1027 participants were included (mean age 72.8, 57.1% male); 274 with and 753 without renal impairment. 18.7% of the eGFR<60 group had moderate-to-severe SVD burden (score 2-3), compared with 14.0% of those with eGFR>60 (p = 0.039). SVD burden was associated with renal impairment after adjusting for hypertension (OR 1.36, 95% CI 1.04-1.77, p = 0.023), but not after adjusting for age. Cerebral atrophy was more prevalent in patients with eGFR<60 (81.2% vs. 72.0%, p = 0.002), as were WMH (45.6% vs. 36.6%, p = 0.026). Neither was associated with renal function after adjusting for age and vascular risk factors. Renal impairment was associated with functional outcome (OR 0.65, 95% CI 0.47-0.89, p = 0.007), but not after adjusting for age, pre-morbid function and comorbidities (OR 0.95, 95% CI 0.65-1.38, p = 0.774). CONCLUSION In acute ICH, renal impairment is associated with a higher cerebral SVD burden independent of hypertension, but not age. Reduced eGFR is associated with worse functional outcome, but not independent of age and comorbidities. Since CT has limited sensitivity to detect SVD severity and distribution, further studies including MRI are needed.
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Affiliation(s)
- Philip S Nash
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Jonathan G Best
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Gargi Banerjee
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Isabel C Hostettler
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK; Neurosurgical Department, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - David Seiffge
- Department of Neurology and Stroke Center, Inselspital, Bern, Switzerland
| | - Hannah Cohen
- Department of Haematology, University College London, Chenies Mews, UK
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin M Brown
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.
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Husain-Syed F, Takeuchi T, Neyra JA, Ramírez-Guerrero G, Rosner MH, Ronco C, Tolwani AJ. Acute kidney injury in neurocritical care. Crit Care 2023; 27:341. [PMID: 37661277 PMCID: PMC10475203 DOI: 10.1186/s13054-023-04632-1] [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: 04/18/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
Approximately 20% of patients with acute brain injury (ABI) also experience acute kidney injury (AKI), which worsens their outcomes. The metabolic and inflammatory changes associated with AKI likely contribute to prolonged brain injury and edema. As a result, recognizing its presence is important for effectively managing ABI and its sequelae. This review discusses the occurrence and effects of AKI in critically ill adults with neurological conditions, outlines potential mechanisms connecting AKI and ABI progression, and highlights AKI management principles. Tailored approaches include optimizing blood pressure, managing intracranial pressure, adjusting medication dosages, and assessing the type of administered fluids. Preventive measures include avoiding nephrotoxic drugs, improving hemodynamic and fluid balance, and addressing coexisting AKI syndromes. ABI patients undergoing renal replacement therapy (RRT) are more susceptible to neurological complications. RRT can negatively impact cerebral blood flow, intracranial pressure, and brain tissue oxygenation, with effects tied to specific RRT methods. Continuous RRT is favored for better hemodynamic stability and lower risk of dialysis disequilibrium syndrome. Potential RRT modifications for ABI patients include adjusted dialysate and blood flow rates, osmotherapy, and alternate anticoagulation methods. Future research should explore whether these strategies enhance outcomes and if using novel AKI biomarkers can mitigate AKI-related complications in ABI patients.
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Affiliation(s)
- Faeq Husain-Syed
- Division of Nephrology, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Tomonori Takeuchi
- Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ku, Tokyo, 113-8510, Japan
| | - Javier A Neyra
- Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, San Ignacio 725, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, San Ignacio 725, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Hontaneda 2653, Valparaíso, Chile
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA
| | - Claudio Ronco
- Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2, 35128, Padua, Italy
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Ashita J Tolwani
- Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Farag YM, Blasco-Colmenares E, Zhao D, Sanon M, Guallar E, Finkelstein FO. Effect of Anemia on Physical Function and Physical Activity in CKD: The National Health and Nutrition Examination Survey, 1999-2016. KIDNEY360 2023; 4:e1212-e1222. [PMID: 37768811 PMCID: PMC10550006 DOI: 10.34067/kid.0000000000000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/11/2023] [Indexed: 09/30/2023]
Abstract
Key Points In a large sample representative of the US adult noninstitutionalized population, among participants with CKD stages 3–5, anemia was associated with a significantly lower level of physical activity. The presence of CKD and anemia showed a positive interaction on physical functioning outcomes. Among participants with CKD, physical functioning was worse in patients with anemia compared with those without anemia. Background CKD is a major public health problem worldwide. Anemia, a frequent and treatable complication of CKD, is associated with decreased physical functioning and physical activity. The objective of this study was to evaluate the joint association of CKD and anemia with physical functioning and physical activity in a representative sample of the US population. Methods Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 1999–2016 for physical functioning outcomes (N =33,300) and NHANES 2007–2016 for physical activity (N =22,933). The NHANES physical functioning questionnaire included 19 items. The NHANES physical activity questionnaire captured work-related, leisure-time, and sedentary activities. Higher physical functioning scores represent worse function. CKD was classified using Kidney Disease Outcomes Quality Initiative 2002 criteria, and anemia was defined using the World Health Organization criteria. Results The adjusted mean differences (95% confidence interval) in overall physical functioning score comparing participants with anemia with those without anemia among participants with no CKD, CKD stages 1–2, and stages 3–5 were 0.5 (−0.1 to 1.0), 1.5 (0.2 to 2.8), and 3.6 (2.0 to 5.2). Anemia and CKD showed a supra-additive interaction for all physical functioning outcomes among participants in CKD stages 3–5. The prevalence of high physical activity was also lower in participants with anemia compared with those without anemia among participants in CKD stages 3–5 (adjusted prevalence ratio, 0.74; 95% confidence interval, 0.54 to 1.01). Conclusions CKD and anemia were associated with impairments in physical functioning and reduced physical activity. For physical functioning outcomes, the combined presence of CKD and of anemia showed a stronger effect than what was expected from their independent effects.
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Affiliation(s)
- Youssef M.K. Farag
- Akebia Therapeutics, Inc., Cambridge, Massachusetts
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Elena Blasco-Colmenares
- Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
- Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Myrlene Sanon
- Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
- Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Aoki J, Kaya C, Khalid O, Kothari T, Silberman MA, Skordis C, Hughes J, Hussong J, Salama ME. CKD Progression Prediction in a Diverse US Population: A Machine-Learning Model. Kidney Med 2023; 5:100692. [PMID: 37637863 PMCID: PMC10457449 DOI: 10.1016/j.xkme.2023.100692] [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] [Indexed: 08/29/2023] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) is a major cause of morbidity and mortality. To date, there are no widely used machine-learning models that can predict progressive CKD across the entire disease spectrum, including the earliest stages. The objective of this study was to use readily available demographic and laboratory data from Sonic Healthcare USA laboratories to train and test the performance of machine learning-based predictive risk models for CKD progression. Study Design Retrospective observational study. Setting & Participants The study population was composed of deidentified laboratory information services data procured from a large US outpatient laboratory network. The retrospective data set included 110,264 adult patients over a 5-year period with initial estimated glomerular filtration rate (eGFR) values between 15-89 mL/min/1.73 m2. Predictors Patient demographic and laboratory characteristics. Outcomes Accelerated (ie, >30%) eGFR decline associated with CKD progression within 5 years. Analytical Approach Machine-learning models were developed using random forest survival methods, with laboratory-based risk factors analyzed as potential predictors of significant eGFR decline. Results The 7-variable risk classifier model accurately predicted an eGFR decline of >30% within 5 years and achieved an area under the curve receiver-operator characteristic of 0.85. The most important predictor of progressive decline in kidney function was the eGFR slope. Other key contributors to the model included initial eGFR, urine albumin-creatinine ratio, serum albumin (initial and slope), age, and sex. Limitations The cohort study did not evaluate the role of clinical variables (eg, blood pressure) on the performance of the model. Conclusions Our progressive CKD classifier accurately predicts significant eGFR decline in patients with early, mid, and advanced disease using readily obtainable laboratory data. Although prospective studies are warranted, our results support the clinical utility of the model to improve timely recognition and optimal management for patients at risk for CKD progression. Plain-Language Summary Defined by a significant decrease in estimated glomerular filtration rate (eGFR), chronic kidney disease (CKD) progression is strongly associated with kidney failure. However, to date, there are no broadly used resources that can predict this clinically significant event. Using machine-learning techniques on a diverse US population, this cohort study aimed to address this deficiency and found that a 5-year risk prediction model for CKD progression was accurate. The most important predictor of progressive decline in kidney function was the eGFR slope, followed by the urine albumin-creatinine ratio and serum albumin slope. Although further study is warranted, the results showed that a machine-learning model using readily obtainable laboratory information accurately predicts CKD progression, which may inform clinical diagnosis and management for this at-risk population.
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Bobot M, Suissa L, Hak JF, Burtey S, Guillet B, Hache G. Kidney disease and stroke: epidemiology and potential mechanisms of susceptibility. Nephrol Dial Transplant 2023; 38:1940-1951. [PMID: 36754366 DOI: 10.1093/ndt/gfad029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Indexed: 02/10/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of both ischaemic and haemorrhagic stroke compared with the general population. Both acute and chronic kidney impairment are independently associated with poor outcome after the onset of a stroke, after adjustment for confounders. End-stage kidney disease (ESKD) is associated with a 7- and 9-fold increased incidence of both ischaemic and haemorrhagic strokes, respectively, poorer neurological outcome and a 3-fold higher mortality. Acute kidney injury (AKI) occurs in 12% of patients with stroke and is associated with a 4-fold increased mortality and unfavourable functional outcome. CKD patients seem to have less access to revascularisation techniques like thrombolysis and thrombectomy despite their poorer prognosis. Even if CKD patients could benefit from these specific treatments in acute ischaemic stroke, their prognosis remains poor. After thrombolysis, CKD is associated with a 40% increased risk of intracerebral haemorrhage (ICH), a 20% increase in mortality and poorer functional neurological outcomes. After thrombectomy, CKD is not associated with ICH but is still associated with increased mortality, and AKI with unfavourable outcome and mortality. The beneficial impact of gliflozins on the prevention of stroke is still uncertain. Non-traditional risk factors of stroke, like uraemic toxins, can lead to chronic cerebrovascular disease predisposing to stroke in CKD, notably through an increase in the blood-brain barrier permeability and impaired coagulation and thrombosis mechanisms. Preclinical and clinical studies are needed to specifically assess the impact of these non-traditional risk factors on stroke incidence and outcomes, aiming to optimize and identify potential therapeutic targets.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
| | - Laurent Suissa
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- Unité Neurovasculaire/Stroke Center, Hôpital de la Timone, AP-HM, Marseille, France
| | - Jean-François Hak
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiologie, Hôpital de la Timone, AP-HM, Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
| | - Benjamin Guillet
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiopharmacie, AP-HM, Marseille, France
| | - Guillaume Hache
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Pharmacie, Hôpital de la Timone, AP-HM, Marseille, France
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Nagaraja N, Farooqui A, Reddy VBN, Shukla AM. Kidney impairment and outcomes in acute ischaemic stroke. Intern Med J 2023; 53:1231-1239. [PMID: 35717661 PMCID: PMC9760780 DOI: 10.1111/imj.15852] [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: 12/16/2021] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased risk of stroke and mortality. AIMS To evaluate the clinical and imaging features and outcomes of patients with and without kidney impairment among t admitted for acute ischaemic stroke (AIS). METHODS AIS patients with brain magnetic resonance imaging (MRI) were included in the study. Kidney impairment was defined by an admission estimated glomerular filtration rate < 60 mL/min/1.73 m2 . Cerebral microbleeds (CMB) and white matter hyperintensities (WMH) were evaluated using the Microbleed Anatomical Rating Scale and Fazekas scales, respectively. Primary outcomes were defined by modified Rankin Scale (mRS) and discharge disposition. Multivariate logistic regression analysis was performed to evaluate factors associated with the presence of kidney impairment and poor discharge outcomes. RESULTS Of the 285 patients with AIS, 80 had kidney impairment on admission. Patients with kidney impairment were older (mean age ± standard deviation: 74.7 ± 12.9 vs 64.4 ± 13.8 years, P < 0.0001) and had more neurological deficits on National Institutes of Health Stroke Scale (NIHSS) score (median 8.5 vs 5, P = 0.02). In unadjusted analysis, patients with kidney impairment were less likely to have a good functional outcome (mRS 0-2: 36% vs 57%, P = 0.002) and good discharge outcome (home or inpatient rehabilitation: 68% vs 82%, P = 0.008). On multivariate analysis, kidney impairment was associated with higher NIHSS score (odds ratio (OR) = 1.04; 95% confidence interval (CI) = 1.002-1.08) and severe WMH (OR = 1.99; 95% CI = 1.06-3.77) suggestive of small vessel disease, but kidney impairment was not associated with poor discharge outcome (OR = 1.62; 95% CI = 0.75-3.53). CONCLUSION Presence of kidney impairment at the time of stroke presentation, regardless of previous renal function, is associated with more neurological deficits and severe WMH on MRI.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Amreen Farooqui
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Ashutosh M Shukla
- North Florida/South Georgia VHS and Division of Nephrology, Department of Medicine, University of Florida, Gainesville, FL, USA
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Wang J, Xiao J, Wang R, Wang D. Influencing factors of cardiac valve calcification (CVC) in patients with chronic kidney disease and the impact of CVC on long-term prognosis: a single-center retrospective study. PeerJ 2023; 11:e15569. [PMID: 37404480 PMCID: PMC10317020 DOI: 10.7717/peerj.15569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Objective To investigate the effect of cardiac valve calcification (CVC) on the prognosis of patients with chronic kidney disease (CKD). Methods A total of 343 CKD patients were retrospectively analyzed, and divided into two groups according to the presence or absence of cardiac valve calcification. All patients were followed until death, loss to follow-up, or the end point of the study (December 2021). Results The incidence of CVC among the 343 CKD patients was 29.7%, including 21 cases of mitral valve calcification, 63 cases of aortic valve calcification, and 18 cases of mitral valve combined with aortic valve calcification. The incidence of CVC in CKD stages 1-2 was 0.3%, 5.2% in CKD stages 3-4, and 24.2% in CKD stage 5 (P < 0.05). Advanced age, higher serum albumin, higher cystatin C and lower uric acid levels were all associated with a higher risk of CVC. After six years of follow-up, 77 patients (22.4%) died. The causes of death were cardiovascular and cerebrovascular diseases in 36 cases (46.7%), infection in 29 cases (37.7%), gastrointestinal bleeding in nine cases (11.7%), and "other" in the remaining three cases (3.9%). A Kaplan Meier survival analysis showed that the overall survival rate of patients with CVC was lower than that of patients without CVC. Conclusion The incidence of CVC, mainly aortic calcification, is high in patients with CKD. Advanced age, higher serum albumin and higher cystatin C levels were associated with a higher risk of CVC. Hyperuricemia was associated with a lower risk of CVC. The overall survival rate of patients with CVC was lower than that of patients without CVC.
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Affiliation(s)
- Ju Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Jianping Xiao
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Ruifeng Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Deguang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
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Vincent F, Redfors B, Kotinkaduwa LN, Kar S, Lim DS, Mishell JM, Whisenant BK, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Cerebrovascular Events After Transcatheter Edge-to-Edge Repair and Guideline-Directed Medical Therapy in the COAPT Trial. JACC Cardiovasc Interv 2023; 16:1448-1459. [PMID: 37380226 DOI: 10.1016/j.jcin.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Little is known regarding the risk of cerebrovascular events (CVE) in patients with heart failure and severe secondary mitral regurgitation treated with transcatheter edge-to-edge repair (TEER). OBJECTIVES The study sought to examine the incidence, predictors, timing, and prognostic impact of CVE (stroke or transient ischemic attack) in the COAPT (Cardiovascular Outcomes Assessment of the Mitraclip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. METHODS A total of 614 patients with heart failure and severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) vs GDMT alone. RESULTS At 4-year follow-up, 50 CVEs occurred in 48 (7.8%) of the 614 total patients enrolled in the COAPT trial; Kaplan-Meier event rates were 12.3% in the TEER group and 10.2 in the GDMT alone group (P = 0.91). Within 30 days of randomization, CVE occurred in 2 (0.7%) patients randomized to TEER and 0% randomized to GDMT (P = 0.15). Baseline renal dysfunction and diabetes were independently associated with increased risk of CVE, while baseline anticoagulation was associated with a reduction of CVE. A significant interaction was present between treatment group and anticoagulation such that TEER compared with GDMT alone was associated with a reduced risk of CVE among patients with anticoagulation (adjusted HR: 0.24; 95% CI: 0.08-0.73) compared with an increased risk of CVE in patients without anticoagulation (adjusted HR: 2.27; 95% CI: 1.08-4.81; Pinteraction = 0.001). CVE was an independent predictor of death within 30 days after the event (HR: 14.37; 95% CI: 7.61, 27.14; P < 0.0001). CONCLUSIONS In the COAPT trial, the 4-year rate of CVE was similar after TEER or GDMT alone. CVE was strongly associated with mortality. Whether anticoagulation is effective at reducing CVE risk after TEER warrants further study. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT); NCT01626079).
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Affiliation(s)
- Flavien Vincent
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Regional Hospital ISSSTE Puebla, Puebla, Mexico
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob M Mishell
- Kaiser Permanente San Francisco Hospital, San Francisco, California, USA
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Sprick JD, Jeong J, Sabino-Carvalho JL, Li S, Park J. Neurocirculatory regulation and adaptations to exercise in chronic kidney disease. Am J Physiol Heart Circ Physiol 2023; 324:H843-H855. [PMID: 37000610 PMCID: PMC10191135 DOI: 10.1152/ajpheart.00115.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023]
Abstract
Chronic kidney disease (CKD) is characterized by pronounced exercise intolerance and exaggerated blood pressure reactivity during exercise. Classic mechanisms of exercise intolerance in CKD have been extensively described previously and include uremic myopathy, chronic inflammation, malnutrition, and anemia. We contend that these classic mechanisms only partially explain the exercise intolerance experienced in CKD and that alterations in cardiovascular and autonomic regulation also play a key contributing role. The purpose of this review is to examine the physiological factors that contribute to neurocirculatory dysregulation during exercise and discuss the adaptations that result from regular exercise training in CKD. Key neurocirculatory mechanisms contributing to exercise intolerance in CKD include augmentation of the exercise pressor reflex, aberrations in neurocirculatory control, and increased neurovascular transduction. In addition, we highlight how some contributing factors may be improved through exercise training, with a specific focus on the sympathetic nervous system. Important areas for future work include understanding how the exercise prescription may best be optimized in CKD and how the beneficial effects of exercise training may extend to the brain.
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Affiliation(s)
- Justin D Sprick
- Department of Kinesiology, Health Promotion and Recreation, University of North Texas, Denton, Texas, United States
| | - Jinhee Jeong
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia, United States
| | - Jeann L Sabino-Carvalho
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia, United States
| | - Sabrina Li
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia, United States
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs Health Care System, Research Service Line, Decatur, Georgia, United States
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Ghoshal S. Renal and Electrolyte Disorders and the Nervous System. Continuum (Minneap Minn) 2023; 29:797-825. [PMID: 37341331 DOI: 10.1212/con.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Neurologic complications are a major contributor to death and disability in patients with renal disease. Oxidative stress, endothelial dysfunction, accelerated arteriosclerosis, and uremic inflammatory milieu affect both the central and peripheral nervous systems. This article reviews the unique contributions of renal impairment to neurologic disorders and their common clinical manifestations as the prevalence of renal disease increases in a globally aging population. LATEST DEVELOPMENT Advances in the understanding of the pathophysiologic interplay between the kidneys and brain, also referred to as the kidney-brain axis, have led to more widespread recognition of associated changes in neurovascular dynamics, central nervous system acidification, and uremia-associated endothelial dysfunction and inflammation in the central and peripheral nervous systems. Acute kidney injury increases mortality in acute brain injury to nearly 5 times that seen in matched controls. Renal impairment and its associated increased risks of intracerebral hemorrhage and accelerated cognitive decline are developing fields. Dialysis-associated neurovascular injury is increasingly recognized in both continuous and intermittent forms of renal replacement therapy, and treatment strategies for its prevention are evolving. ESSENTIAL POINTS This article summarizes the effects of renal impairment on the central and peripheral nervous systems with special considerations in acute kidney injury, patients requiring dialysis, and conditions that affect both the renal and nervous systems.
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Kurvits S, Harro A, Reigo A, Ott A, Laur S, Särg D, Tampuu A, Alasoo K, Vilo J, Milani L, Haller T. Common clinical blood and urine biomarkers for ischemic stroke: an Estonian Electronic Health Records database study. Eur J Med Res 2023; 28:133. [PMID: 36966315 PMCID: PMC10039346 DOI: 10.1186/s40001-023-01087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 03/04/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Ischemic stroke (IS) is a major health risk without generally usable effective measures of primary prevention. Early warning signals that are easy to detect and widely available can save lives. Estonia has one nation-wide Electronic Health Record (EHR) database for the storage of medical information of patients from hospitals and primary care providers. METHODS We extracted structured and unstructured data from the EHRs of participants of the Estonian Biobank (EstBB) and evaluated different formats of input data to understand how this continuously growing dataset should be prepared for best prediction. The utility of the EHR database for finding blood- and urine-based biomarkers for IS was demonstrated by applying different analytical and machine learning (ML) methods. RESULTS Several early trends in common clinical laboratory parameter changes (set of red blood indices, lymphocyte/neutrophil ratio, etc.) were established for IS prediction. The developed ML models predicted the future occurrence of IS with very high accuracy and Random Forests was proved as the most applicable method to EHR data. CONCLUSIONS We conclude that the EHR database and the risk factors uncovered are valuable resources in screening the population for risk of IS as well as constructing disease risk scores and refining prediction models for IS by ML.
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Affiliation(s)
- Siim Kurvits
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ainika Harro
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anu Reigo
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anne Ott
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Sven Laur
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Dage Särg
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Ardi Tampuu
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | | | - Kaur Alasoo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Lili Milani
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Toomas Haller
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia.
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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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Zhang Y, Liu D, Ma Z, Wang C, Gu S, Zhou Z, Zuo H. Plasma β-Alanine is Positively Associated With Risk of Ischemic Stroke: a Nested Case-Control Study. J Nutr 2023; 153:1162-1169. [PMID: 36854355 DOI: 10.1016/j.tjnut.2023.02.029] [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: 11/26/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Previous studies suggested that β-alanine as a neurotransmitter could affect the pathogenesis of ischemic damage. However, the association between circulating β-alanine and risk of ischemic stroke (IS) has not been evaluated in populations. OBJECTIVES We aimed to examine the association between β-alanine and IS risk in a nested case-control study. METHODS We performed a case-control study nested within a prospective community-based cohort (n = 16457; median follow-up time: 5.3 y), which included 321 incident IS cases and 321 controls matched by age and sex. Β-alanine and other metabolites were measured in plasma after overnight fasting by LC-MS/MS. The association of β-alanine with risk of IS was evaluated by conditional logistic regression. BMI, current smoking, educational attainment, physical activity, total energy intake, family history of stroke, hypertension, diabetes, hyperlipidemia, and estimated GFR were adjusted in multivariable models. RESULTS There was a significant Spearman partial correlation between β-alanine and 4-pyridoxic acid (ρ = 0.239; P < 0.001). Participants with elevated β-alanine levels were more likely to develop IS with an adjusted OR of 1.26 (95% CI: 1.06-1.51; P = 0.011) (per standard deviation increment). This association remained significant after excluding the first 2 y of follow-up, and after further adjustment for red meat intake, total protein intake, medication use, or vitamin B6 indicators. CONCLUSIONS Our novel findings revealed that plasma β-alanine at baseline were positively associated with risk of IS and may function as an early biomarker of IS risk.
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Affiliation(s)
- Ya Zhang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dong Liu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Ze Ma
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Cuicui Wang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Shujun Gu
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Zhengyuan Zhou
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1209] [Impact Index Per Article: 1209.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Altered Cerebral Blood Flow in the Progression of Chronic Kidney Disease. J Pers Med 2023; 13:jpm13010142. [PMID: 36675803 PMCID: PMC9863421 DOI: 10.3390/jpm13010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
Background: In chronic kidney disease (CKD), cognitive impairment is a definite complication. However, the mechanisms of how CKD leads to cognitive impairment are not clearly known. Methods: Cerebral blood flow (CBF) information was collected from 37 patients with CKD (18 in stage 3; 19 in stage 4) and 31 healthy controls (HCs). For CKD patients, we also obtained laboratory results as well as neuropsychological tests. We conducted brain perfusion imaging studies using arterial spin labeling and calculated the relationship between regional CBF changes and various clinical indicators and neuropsychological tests. We also generated receiver operator characteristic (ROC) curves to explore whether CBF value changes in certain brain regions can be used to identify CKD. Results: Compared with HCs, CBF decreased in the right insula and increased in the left hippocampus in the CKD4 group; through partial correlation analysis, we found that CBF in the right insula was negatively correlated with the number connection test A (NCT-A) (r = −0.544, p = 0.024); CBF in the left hippocampus was positively correlated with blood urea nitrogen (r = 0.649, p = 0.005) and negatively correlated with serum calcium level (r = −0.646, p = 0.005). By comparing the ROC curve area, it demonstrated that altered CBF values in the right insula (AUC = 0.861, p < 0.01) and left hippocampus (AUC = 0.862, p < 0.01) have a good ability to identify CKD. Conclusions: Our study found that CBF alterations in the left hippocampus and the right insula brain of adult patients with stage 4 CKD were correlated with disease severity or laboratory indicators. These findings provide further insight into the relationship between altered cerebral perfusion and cognitive impairment in patients with non-end-stage CKD as well as, additional information the underlying neuropathophysiological mechanisms.
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Xiao CY, Ma YH, Ou YN, Zhao B, Hu HY, Wang ZT, Tan L. Association between Kidney Function and the Burden of Cerebral Small Vessel Disease: An Updated Meta-Analysis and Systematic Review. Cerebrovasc Dis 2023; 52:376-386. [PMID: 36599326 DOI: 10.1159/000527069] [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: 07/25/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Due to anatomical and functional similarities in microvascular beds, the brain and kidney share distinctive susceptibilities to vascular injury and common risk factors of small vessel disease. The aim of this updated meta-analysis is to explore the association between kidney function and the burden of cerebral small vessel disease (CSVD). METHODS PubMed, EMBASE, and Cochrane Library were systematically searched for observational studies that explored the association between the indicators of kidney function and CSVD neuroimaging markers. The highest-adjusted risk estimates and their 95% confidence intervals (CIs) were aggregated using random-effect models. RESULTS Twelve longitudinal studies and 51 cross-sectional studies with 57,030 subjects met the inclusion criteria of systematic review, of which 52 were included in quantitative synthesis. According to the pooled results, we found that low estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2) was associated with cerebral microbleeds (odds ratio (OR) = 1.55, 95% CI = 1.26-1.90), white matter hyperintensities (OR = 1.40, 95% CI = 1.05-1.86), and lacunar infarctions (OR = 1.50, 95% CI = 1.18-1.92), but not with severe perivascular spaces (OR = 1.20, 95% CI = 0.77-1.88). Likewise, patients with proteinuria (OR = 1.75, 95% CI = 1.47-2.09) or elevated serum cystatin C (OR = 1.51, 95% CI = 1.25-1.83) also had an increased risk of CSVD. CONCLUSION The association between kidney function and CSVD has been comprehensively updated through this study, that kidney insufficiency manifested as low eGFR, proteinuria, and elevated serum cystatin C was independently associated with CSVD burden.
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Affiliation(s)
- Chu-Yun Xiao
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Bing Zhao
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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Sakai S, Hagii J, Shikanai S, Sorimachi Y, Hamaura S, Yamazaki K, Yamada N, Shiroto H, Saito S, Kamada T, Takanashi S, Okumura K, Tomita H. Low Creatinine Clearance Is a Risk Factor for Severe Cardioembolic Stroke in Japanese Female Patients. In Vivo 2023; 37:336-344. [PMID: 36593049 PMCID: PMC9843754 DOI: 10.21873/invivo.13084] [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: 10/18/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIM The relationship between renal function and severity of cardioembolic stroke (CES) stratified by sex remains poorly understood. PATIENTS AND METHODS A total of 640 consecutive CES patients within 48 h after stroke onset and with a modified Rankin Scale (mRS) score of 0 or 1 before onset were studied. The patients were divided into three groups based on their CCr values: low creatinine clearance (CCr) (L-CCr) (n=71, <30 ml/min), middle CCr (M-CCr) (n=227, 30 to <50 ml/min), and high CCr (H-CCr) (n=342, ≥50 ml/min). We compared the severity and functional outcomes of stroke among the three groups according to sex. RESULTS On admission, using the National Institutes of Health Stroke Scale, the L-CCr group had the most severe stroke, followed by the M-CCr and H-CCr groups (p<0.0001). Functional outcomes at discharge, assessed using the mRS, were the worst in the L-CCr group, followed by the M-CCr and H-CCr groups (p<0.0001). Multivariable analyses revealed that L-CCr was a significant determinant of severe stroke on admission and poor functional outcomes at discharge. According to sex, L-CCr was a significant determinant of severe stroke on admission and poor functional outcomes at discharge in female patients, but not in male patients. CONCLUSION Low CCr is a risk factor for severe stroke on admission and unfavorable functional outcomes at discharge in Japanese CES patients, and particularly in female patients.
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Affiliation(s)
- Shuntaro Sakai
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Shun Shikanai
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuya Sorimachi
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shogo Hamaura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Yamazaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Natsumi Yamada
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Shin Saito
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan;
- Department of Stroke and Cerebrovascular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Hsieh CY, Sung SF. From Kidney Protection to Stroke Prevention: The Potential Role of Sodium Glucose Cotransporter-2 Inhibitors. Int J Mol Sci 2022; 24:ijms24010351. [PMID: 36613795 PMCID: PMC9820650 DOI: 10.3390/ijms24010351] [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: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for stroke and covert cerebrovascular disease, and up to 40% of stroke patients have concomitant CKD. However, the so-called "cerebrorenal interaction" attracted less attention compared to its cardiorenal counterpart. Diabetes is the leading cause of CKD. The sodium-glucose cotransporter (SGLT) 2 inhibitor is a relatively new class of oral anti-diabetic drugs and has cardiorenal benefits in addition to glucose-lowering effects. In the present perspective, we would like to review the current status and future potential of the SGLT2 inhibitor in cerebro-renal interactions and strokes regardless of the status of diabetes. We propose the potential roles of baseline renal functions and SGLT1/2 dual inhibition in stroke prevention, as well as the additional benefits of reducing atrial fibrillation and hemorrhagic stroke for SGLT2 inhibitors. Further clinical trials are anticipated to test whether SGLT2 inhibitors can fulfill the long-standing unmet clinical need and stop such a vicious cycle of cerebro-renal interaction.
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Affiliation(s)
- Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan 701, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
- Department of Beauty & Health Care, Min-Hwei Junior College of Health Care Management, Tainan 736, Taiwan
- Correspondence: ; Tel.: +886-5-276-5041 (ext. 7284)
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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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Seifu L, Gashaye Y, Taye M. Renal Function Abnormalities among Patients with Acute Stroke at a Tertiary Hospital in Ethiopia. Ethiop J Health Sci 2022; 32:1175-1182. [PMID: 36475245 PMCID: PMC9692161 DOI: 10.4314/ejhs.v32i6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
Background Stroke is the leading cause of neurological disability and the second commonest cause of death globally. Despite the fact that renal dysfunction is a common comorbidity of stroke, there is no data on the prevalence of renal dysfunction among patients with acute stroke in Ethiopia. The aim of this study was to determine the magnitude of renal dysfunction, factors associated with renal dysfunction and risk of in-hospital mortality. Methods A hospital-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College among consecutive 192 patients, who were admitted with acute stroke from September 2020 to September 2021. Data were collected using a structured questionnaire after pilot survey was done. A Multivariate binary logistic regression analysis was fitted to identify determinants of renal function abnormalities. Renal dysfunction was defined as serum creatinine >1.2mg/dl. Result The mean age (SD) of study participants was 62.2 (15.9) years. Hundred-one (52.6%) participants were males. Thirty-four (17.7%) of the participants had renal dysfunction. Among patients with renal dysfunction, more than half of them were ≥70 years old and two-thirds were males. Male gender and hypertension increased the risk of renal dysfunction among hospitalized stroke patients. The mortality rate was higher in stroke patients with renal dysfunction (35.3%) as compared with patients having normal renal function (15.2%), but it was not a statistically significant. Conclusion Renal dysfunction was a frequent comorbidity among acute stroke patients who were hospitalized. Male gender and hypertension were statistically significant predictors of renal dysfunction. Mortality rate was higher in stroke patients with renal dysfunction, but not a statistically significant predictor of post stroke in-hospital mortality.
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Affiliation(s)
- Lissane Seifu
- Department of Internal Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Gashaye
- Department of Public Health, Santé Medical College, Addis Ababa, Ethiopia
| | - Melaku Taye
- Department of Internal Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Lahad K, Maor E, Klempfner R, Grossman C, Druyan A, Ben-Zvi I. CHA2DS2-VASC Score Predicts the Risk of Stroke in Patients Hospitalized to the Internal Medicine Department Without Known Atrial Fibrillation. J Gen Intern Med 2022; 37:3355-3360. [PMID: 35622270 PMCID: PMC9550949 DOI: 10.1007/s11606-021-07262-x] [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: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The CHA2DS2-VASC score is used to assess the risk of cerebrovascular accident (CVA) in patients with atrial fibrillation (AF) or atrial flutter (AFL). OBJECTIVES We aimed to determine whether this score can determine the risk of CVA during the first year after hospitalization, in patients without known AF/AFL. DESIGN Single-center retrospective cohort. PATIENTS We included all patients aged ≥ 50 who were hospitalized between January 1, 2008, and December 31, 2018, to the internal medicine departments at the Chaim Sheba Medical Center, Israel. Exclusion criteria included history or new diagnosis of CVA, TIA, and AF/AFL and use of anticoagulation at any time. MAIN MEASURES Patients were stratified into 3 groups according to their CHA2DS2-VASC score (0-1, 2, or ≥ 3). The primary outcome was hospitalization with CVA/TIA within one year of the index hospitalization. KEY RESULTS Of the patients, 52,206 were included in the study. CVA/TIA occurred in 0.7%, 1.3%, and 1.7% of patients with a CHA2DS2-VASC score of 0-1, 2, and ≥ 3, respectively. Compared to a CHA2DS2-VASC score of 0-1, the HR for CVA/TIA occurrence for CHA2DS2-VASC scores of 2 and ≥ 3 was 1.77 (CI 1.42, 2.22) and 2.33 (CI 1.9, 2.85), respectively (p < 0.001 for both comparisons). Each additional CHA2DS2-VASC point increased the probability for readmission with CVA/TIA within 1-year by 26% (HR 1.26, CI 1.19, 1.32, p < 0.001). Similar trends were seen in subgroup analyses by gender, age, and renal function. CONCLUSIONS The CHA2DS2-VASC score is a predictor for CVA/TIA during the first year after hospitalization in patients without AF. High CHA2DS2-VASC scores warrant work-up for occult AF/AFL and other risk factors for CVA/TIA.
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Affiliation(s)
- Karney Lahad
- Department of Internal Medicine F, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Cardiac Rehabilitation Institute, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chagai Grossman
- Department of Internal Medicine F, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Druyan
- Department of Internal Medicine F, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Ben-Zvi
- Department of Internal Medicine F, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel.
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Abbas K, Lu Y, Bavishi S, Mishra N, TomThundyil S, Sawant SA, Shahjouei S, Abedi V, Zand R. A Simple Review of Small Vessel Disease Manifestation in the Brain, Retina, and Kidneys. J Clin Med 2022; 11:jcm11195546. [PMID: 36233417 PMCID: PMC9573636 DOI: 10.3390/jcm11195546] [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: 07/31/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Small blood vessels express specific phenotypical and functional characteristics throughout the body. Alterations in the microcirculation contribute to many correlated physiological and pathological events in related organs. Factors such as comorbidities and genetics contribute to the complexity of this topic. Small vessel disease primarily affects end organs that receive significant cardiac output, such as the brain, kidney, and retina. Despite the differences in location, concurrent changes are seen in the micro-vasculature of the brain, retina, and kidneys under pathological conditions due to their common histological, functional, and embryological characteristics. While the cardiovascular basis of pathology in association with the brain, retina, or kidneys has been well documented, this is a simple review that uniquely considers the relationship between all three organs and highlights the prevalence of coexisting end organ injuries in an attempt to elucidate connections between the brain, retina, and kidneys, which has the potential to transform diagnostic and therapeutic approaches.
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Affiliation(s)
- Kinza Abbas
- School of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA
| | - Yezhong Lu
- School of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA
| | - Shreya Bavishi
- Cell and Molecular Biology Department, Tulane University, New Orleans, LA 70118, USA
| | - Nandini Mishra
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Saumya TomThundyil
- School of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Shreeya Atul Sawant
- School of Medicine, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL 60515, USA
| | - Shima Shahjouei
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Ramin Zand
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence: ; Tel.: +1-800-275-6401
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Wagner B, Hert L, Polymeris AA, Schaedelin S, Lieb JM, Seiffge DJ, Traenka C, Thilemann S, Fladt J, Altersberger VL, Zietz A, Dittrich TD, Fisch U, Gensicke H, De Marchis GM, Bonati LH, Lyrer PA, Engelter ST, Peters N. Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry. Front Neurol 2022; 13:964723. [PMID: 36203998 PMCID: PMC9531011 DOI: 10.3389/fneur.2022.964723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC).MethodsObservational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-imaging was performed to assess CMBs. Outcome measures consisted of recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), death, and their combined analysis. Functional disability was assessed by mRS. Using adjusted logistic regression and Cox proportional-hazards models, we assessed the association of the presence of CMBs and OAC type (vitamin K antagonists [VKAs] vs. direct oral anticoagulants [DOACs]) with clinical outcome.ResultsOf 310 AF-stroke patients treated with OAC [DOACs: n = 234 (75%); VKAs: n = 76 (25%)], CMBs were present in 86 (28%) patients; of these, 66 (77%) received DOACs. In both groups, CMBs were associated with an increased risk for the composite outcome: VKAs: HR 3.654 [1.614; 8.277]; p = 0.002; DOACs: HR 2.230 [1.233; 4.034]; p = 0.008. Patients with CMBs had ~50% higher absolute rates of the composite outcome compared to the overall cohort, with a comparable ratio between treatment groups [VKAs 13/20(65%) vs. DOACs 19/66(29%); p < 0.01]. The VKA-group had a 2-fold higher IS [VKAs:4 (20%) vs. DOACs:6 (9%); p = 0.35] and a 10-fold higher ICH rate [VKAs: 3 (15%) vs. DOACs: 1 (1.5%); p = 0.038]. No significant interaction was observed between type of OAC and presence of CMBs. DOAC-patients showed a significantly better functional outcome (OR 0.40 [0.17; 0.94]; p = 0.04).ConclusionsIn AF-stroke patients treated with OAC, the presence of CMBs was associated with an unfavorable composite outcome for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs.Clinical trial registrationhttp://www.clinicaltrials.gov, Unique identifier: NCT03826927.
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Affiliation(s)
- Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lisa Hert
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alexandros A. Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johanna M. Lieb
- Department of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David J. Seiffge
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Joachim Fladt
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Valerian L. Altersberger
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tolga D. Dittrich
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Urs Fisch
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan T. Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, Switzerland
- Stroke Center, Klinik Hirslanden Zurich, Zurich, Switzerland
- *Correspondence: Nils Peters
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