Reduced kidney function after stroke ups risk of recurrence, dementia

Patients with declining kidney function following a cerebrovascular event are at increased risk of major adverse cardiovascular events (MACE), dementia, and mortality at 2 years, according to a study. However, a higher risk of death is also noted for those with a large increase in kidney function.

Researchers performed a post hoc analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a clinical trial of blood pressure lowering for the secondary prevention of stroke. They assessed the link between dynamic kidney function and recurrent stroke, MACE, dementia, and all-cause death over 2 years using Cox proportional hazard models.

The research team also examined functional relationships using restricted cubic splines and model discrimination using C-statistics and Net Reclassification Improvement (NRI) at 2 years.

In total, 4,591 patients were followed for a mean of 2 years. Of these, 254 (5.5 percent) had a recurrent stroke, 391 (8.5 percent) had a MACE, 221 (4.8 percent) developed dementia, and 271 (5.9 percent) died. Reverse J- or U-like associations were seen for percent declines in estimated glomerular filtration rate (eGFR) and outcomes.

Using declines in eGFR of >0 percent to ≤30 percent as reference, a greater reduction in kidney function (>30 percent) correlated with higher risk of recurrent stroke (adjusted hazard ratio [aHR], 1.85, 95 percent confidence interval [CI], 1.20‒2.85), MACE (aHR, 2.24, 95 percent CI, 1.62‒3.10), and all-cause death (aHR, 2.09, 95 percent CI, 1.39‒3.15).

On the other hand, a larger increase (≥30 percent) in eGFR also appeared to contribute to a higher risk of all-cause death (aHR, 1.96s, 95 percent CI, 1.14‒3.37).

“Improvements in the C-statistic were found by adding baseline eGFR and percent change compared with a model with conventional cardiovascular risk factors alone, for MACE, dementia, and all-cause mortality,” the authors said.