Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study

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

doi:10.1159/000515239

Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study

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

Afdeling for Hjerne- og Nervesygdomme

6 Citationer (Scopus)

Abstract

BACKGROUND: Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association.

AIMS: We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations.

METHODS: INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke.

RESULTS: Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24-1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35-1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17-1.42) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50-3.54 for death within 1 month).

CONCLUSION: Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.

Originalsprog	Engelsk
Tidsskrift	Neuroepidemiology
Vol/bind	55
Udgave nummer	3
Sider (fra-til)	206-215
Antal sider	10
ISSN	0251-5350
DOI	https://doi.org/10.1159/000515239
Status	Udgivet - 1 jun. 2021

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10.1159/000515239

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Smyth, A., Judge, C., Wang, X., Pare, G., Rangarajan, S., Canavan, M., Chin, S. L., Al-Hussain, F., Yusufali, A. M., Elsayed, A., Damasceno, A., Avezum, A., Czlonkowska, A., Rosengren, A., Dans, A. L., Oguz, A., Mondo, C., Weimar, C., Ryglewicz, D., ... INTERSTROKE investigators (2021). Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study. Neuroepidemiology, 55(3), 206-215. https://doi.org/10.1159/000515239

Smyth, A, Judge, C, Wang, X, Pare, G, Rangarajan, S, Canavan, M, Chin, SL, Al-Hussain, F, Yusufali, AM, Elsayed, A, Damasceno, A, Avezum, A, Czlonkowska, A, Rosengren, A, Dans, AL, Oguz, A, Mondo, C, Weimar, C, Ryglewicz, D, Xavier, D, Lanas, F, Malaga, G, Hankey, GJ, Iversen, HK, Zhang, H, Yusoff, K, Pogosova, N, Lopez-Jamarillo, P, Langhorne, P, Diaz, R, Oveisgharan, S, Yusuf, S, O'Donnell, M & INTERSTROKE investigators 2021, 'Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study', Neuroepidemiology, bind 55, nr. 3, s. 206-215. https://doi.org/10.1159/000515239

@article{a5b4b70c6af84d77855038b1b8285cbb,

title = "Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study",

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

keywords = "Kidney disease, Stroke",

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

note = "{\textcopyright} 2021 S. Karger AG, Basel.",

year = "2021",

month = jun,

day = "1",

doi = "10.1159/000515239",

language = "English",

volume = "55",

pages = "206--215",

journal = "Neuroepidemiology",

issn = "0251-5350",

publisher = "S./Karger AG",

number = "3",

}

TY - JOUR

T1 - Renal Impairment and Risk of Acute Stroke

T2 - The INTERSTROKE Study

AU - Smyth, Andrew

AU - Judge, Conor

AU - Wang, Xingu

AU - Pare, Guillaume

AU - Rangarajan, Sumathy

AU - Canavan, Michelle

AU - Chin, Siu Lim

AU - Al-Hussain, Fawaz

AU - Yusufali, Afzalhussein M

AU - Elsayed, Ahmed

AU - Damasceno, Albertino

AU - Avezum, Alvaro

AU - Czlonkowska, Anna

AU - Rosengren, Annika

AU - Dans, Antonio L

AU - Oguz, Aytekin

AU - Mondo, Charles

AU - Weimar, Christian

AU - Ryglewicz, Danuta

AU - Xavier, Denis

AU - Lanas, Fernando

AU - Malaga, German

AU - Hankey, Graeme J

AU - Iversen, Helle K

AU - Zhang, Hongye

AU - Yusoff, Khalid

AU - Pogosova, Nana

AU - Lopez-Jamarillo, Patricio

AU - Langhorne, Peter

AU - Diaz, Rafael

AU - Oveisgharan, Shahram

AU - Yusuf, Salim

AU - O'Donnell, Martin

AU - INTERSTROKE investigators

PY - 2021/6/1

Y1 - 2021/6/1

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

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

KW - Kidney disease

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85105733362&partnerID=8YFLogxK

U2 - 10.1159/000515239

DO - 10.1159/000515239

M3 - Journal article

C2 - 33951632

SN - 0251-5350

VL - 55

SP - 206

EP - 215

JO - Neuroepidemiology

JF - Neuroepidemiology

IS - 3

ER -

Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study

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