Abstract
Background and Purpose-Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods-In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results-Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66-2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49-2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95-2.26 and HR, 2.55; 95% CI, 2.44-2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90-2.18 and HR, 2.46; 95% CI, 2.36-2.56, respectively). Conclusions-Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | 2896-2903 |
| Number of pages | 8 |
| Journal | Stroke |
| Volume | 49 |
| Issue number | 12 |
| DOIs | |
| State | Published - 2018 |
Bibliographical note
Funding Information:Dr El Husseini received research support from a Mini Grant from the Duke O’Brien Center for Kidney Research (primary award National Institutes of Health [NIH] 1P30DK096493–01). Dr Fonarow received research support from the Patient-Centered Outcome Research Institute, NIH/Agency for Healthcare Research and Quality, Get With The Guidelines (GWTG) Steering Committee, and is an employee of University of California, which has a patent on an endovascu-lar device. Dr Schwamm is a chair of American Heart Association GWTG-stroke Clinical Workgroup. Dr Hernandez received other research support from Novartis, Merck Luitpold and, AstraZeneca; and is a consultant/member of advisory board for: Amgen, AstraZeneca, Bayer, Merck, and Novartis. Dr Smith is a member of the GWTG Steering Committee. The other authors report no conflicts.
Funding Information:
The Get With The Guidelines (GWTG)-Stroke program is supported in part by Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke had past support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in the study design or analysis, article preparation, or approval of this study. This work was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (P30DK096493). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2018 American Heart Association, Inc.
Keywords
- Kidney diseases
- Medicare
- Mortality
- Stroke
ASJC Scopus subject areas
- Clinical Neurology
- Cardiology and Cardiovascular Medicine
- Advanced and Specialized Nursing