Renal Dysfunction Is Associated with Poststroke Discharge Disposition and In-Hospital Mortality: Findings from Get with the Guidelines-Stroke
BACKGROUND AND PURPOSE: Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition.
METHODS: In this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1.73 m2). Dialysis was identified by International Classification of Diseases, Ninth Revision codes. Adjusted multivariable Cox proportional hazards models were used to determine the independent associations of eGFR with discharge disposition and in-hospital mortality. Adjusted individual models also examined whether the association of clinical and demographic factors with outcomes varied by eGFR level.
RESULTS: Of 232 236 patients, 47.3% had an eGFR ≥60, 26.6% an eGFR 45 to 59, 16.8% an eGFR 30 to 44, 5.6% an eGFR 15 to 29, 0.7% an eGFRdialysis, and 2.8% were receiving dialysis. Of the total cohort, 11.8% died during the hospitalization or were discharged to hospice, and 38.6% were discharged home. After adjusting for other relevant variables, renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with eGFR(odds ratio, 2.52; 95% confidence interval, 2.07-3.07). An eGFR 15 to 29 (odds ratio, 0.82; 95% confidence interval, 0.78-0.87), eGFR <15 >(odds ratio, 0.72; 95% confidence interval, 0.61-0.86), and dialysis (odds ratio, 0.86; 95% confidence interval, 0.79-0.94) remained associated with lower odds of being discharged home. In addition, the associations of several clinical and demographic factors with outcomes varied by eGFR level.
CONCLUSIONS: eGFR on admission is an important predictor of poststroke short-term outcomes.
Digital Object Identifier (DOI)
The Get With The Guidelines (GWTG)-Stroke program is supported in part by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck.
This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (P30DK096493).
Dr. El Husseini: Research support from the Mini Grant award from the Duke O’Brien Center for Kidney Research. The mini grant award is a sub-award under Duke University’s primary award from the NIH, award number 1P30DK096493–01.
Dr. Fonarow: Other research support from the Patient Centered Outcome Research Institute, NIH/AHRQ, GWTG Steering Committee, and employee of University of California which has a patent on an endovascular device.
Dr. Hernandez: Other research support from Genentech, Daichi, Janssen and, AstraZeneca. Honoraria include AstraZeneca, Bayer and, Novartis.
El Husseini, Nada; Fonarow, Gregg C.; Smith, Eric E.; Ju, Christine; Schwamm, Lee H.; Hernandez, Adrian F.; Schulte, Phillip J.; Xian, Ying; and Goldstein, Larry B., "Renal Dysfunction Is Associated with Poststroke Discharge Disposition and In-Hospital Mortality: Findings from Get with the Guidelines-Stroke" (2017). Neurology Faculty Publications. 42.