Περίληψη:
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.
Συγγραφείς:
Tsagalis, G.
Akrivos, T.
Alevizaki, M.
Manios, E.
Theodorakis, M.
Laggouranis, A.
Vemmos, K.N.
Λέξεις-κλειδιά:
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
