Association of Kidney Function with 30-Day and 1-Year Poststroke Mortality and Hospital Readmission
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 eGFRdialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥ 60, and after adjusting for relevant variables, eGFR(hazard ratio [HR], 2.09; 95% CI, 1.66-2.63). An eGFR(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.
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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. This work was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (P30DK096493).
El Husseini, Nada; Fonarow, Gregg C.; Smith, Eric E.; Ju, Christine; Sheng, Shubin; Schwamm, Lee H.; Hernandez, Adrian F.; Schulte, Phillip J.; Xian, Ying; and Goldstein, Larry B., "Association of Kidney Function with 30-Day and 1-Year Poststroke Mortality and Hospital Readmission" (2018). Neurology Faculty Publications. 39.