Researchers call for more accurate renal assessment in stroke patients

By Laura Cowen

Unrecognised renal insufficiency is common among patients with acute stroke and is associated with a significantly increased risk of in-hospital mortality or severe disability at discharge, say researchers.

The fact that 10.4% of 7900 patients with acute stroke had unrecognised renal insufficiency suggests that estimated glomerular filtration rate (eGFR), rather than serum creatinine levels, should be used to assess renal function in patients with stroke, David Pereg (Meir Medical Center, Kfar-Saba, Israel) and colleagues remark.

The team defined unrecognised renal dysfunction as an eGFR below 60 mL/min per 1.73m² in the presence of normal serum creatinine levels (≤1.2 mg/dL).

In addition to the 819 patients in the prospective National Acute Stroke ISraeli (NASIS) registry with unrecognised renal insufficiency at hospital admission, a further 1510 (19.1%) had recognised renal insufficiency (serum creatinine >1.2 mg/dL, eGFR <60 mL/min per 1.73 m²).

Pereg and co-authors report in The American Journal of Medicine that patients with recognised and unrecognised renal insufficiency had significantly higher in-hospital mortality than those with normal renal function, at respective rates of 9.9%, 9.1% and 4.4%.

And after adjustment for potential confounding variables such as age, gender, and stroke subtype and severity, patients with recognised and unrecognised renal dysfunction were a significant 2.1 and 1.6 times more likely to die in hospital, respectively, than those with normal renal function. But there was no significant difference between the two groups with renal dysfunction.

In addition, patients with renal dysfunction were more likely to experience the composite outcome of in-hospital mortality or severe disability at hospital discharge than those with normal renal function, at adjusted odds ratios of 1.3 and 1.2 for recognised and unrecognised disease, respectively.

Pereg et al conclude: "The fact that this group of patients with unrecognized renal insufficiency had significantly higher mortality rates compared to patients with normal renal function underlines the clinical importance of the more accurate renal function assessment using equations for glomerular filtration rate estimation.

"It is becoming increasingly common for formal laboratory reports to routinely include the estimated glomerular filtration rate and our results should encourage this trend."

Source: Am J Med 2016; Advance online publication

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