TY - JOUR
TI - Long-term prognosis of acute kidney injury after first acute stroke
AU - Tsagalis, G.
AU - Akrivos, T.
AU - Alevizaki, M.
AU - Manios, E.
AU - Theodorakis, M.
AU - Laggouranis, A.
AU - Vemmos, K.N.
JO - Clinical Journal of The American Society of Nephrology
PY - 2009
VL - 4
TODO - 3
SP - 616-622
PB - 
SN - 1555-9041, 1555-905X
TODO - 10.2215/CJN.04110808
TODO - antihypertensive agent;  antithrombocytic agent;  biological marker;  creatinine, aged;  article;  cardiovascular disease;  cardiovascular risk;  cerebrovascular accident;  cohort analysis;  creatinine blood level;  disease association;  disease predisposition;  disease severity;  female;  follow up;  glomerulus filtration rate;  heart failure;  human;  hypertension;  incidence;  kidney injury;  long term care;  major clinical study;  male;  mortality;  observational study;  outcomes research;  prediction;  prognosis;  risk assessment;  acute disease;  blood;  cardiovascular disease;  heart failure;  hospitalization;  Kaplan Meier method;  kidney disease;  middle aged;  pathophysiology;  prediction and forecasting;  proportional hazards model;  prospective study;  risk factor;  stroke;  time, Acute Disease;  Aged;  Aged, 80 and over;  Biological Markers;  Cardiovascular Diseases;  Creatinine;  Female;  Glomerular Filtration Rate;  Heart Failure;  Humans;  Incidence;  Kaplan-Meiers Estimate;  Kidney Diseases;  Male;  Middle Aged;  Predictive Value of Tests;  Prognosis;  Proportional Hazards Models;  Prospective Studies;  Risk Assessment;  Risk Factors;  Severity of Illness Index;  Stroke;  Time Factors
TODO - Background and objectives: Acute kidney injury (AKI) has been associated with increased mortality in a variety of clinical settings. We studied the incidence, predictors, and effect of AKI on long-term overall mortality and cardiovascular events after stroke. Design, setting, participants, & measurements: This was a prospective outcome study of 2155 patients who sustained an acute first-ever stroke and were followed for 10 yr. Patients were divided in two groups: (1) Those with an acute increase (over 48 h) in serum creatinine ≥0.3 mg/dl or a percentage increase of ≥50% and (2) those with a change <0.3 mg/dl, no change at all, or even a reduction. Results: Twenty-seven percent of patients developed AKI after acute stroke. Stroke severity, baseline estimated GFR, heart failure, and stroke subtype predict the occurrence of AKI. The probability of 10-yr mortality for patients with AKI was 75.9 and 57.7 in the patients without AKI (log rank test 45.0; P = 0.001). When patients with AKI were subdivided into three groups according to AKI severity, the probability of 10-yr mortality increased: 73.7, 86.5, and 89.2 in stages 1, 2, and 3, respectively. In Cox proportional hazard analysis, AKI was an independent predictor of 10-yr mortality (P < 0.01) and for the occurrence of new composite cardiovascular events (P < 0.05) after adjustment for available confounding variables. Conclusions: AKI after stroke is a powerful and independent predictor of 10-yr mortality and new composite cardiovascular events. Copyright © 2009 by the American Society of Nephrology.
ER -