03391nas a2200493 4500008004100000022001400041245014300055210006900198260001300267300001200280490000700292520197600299653000902275653001602284653001902300653001602319653001102335653003102346653001102377653002902388653002002417653000902437653001602446653001602462653003202478653002402510653001702534653001102551653001802562100002702580700002102607700002502628700001802653700002602671700001902697700001902716700002002735700002002755700002402775700002102799700002302820700001802843856003602861 2014 eng d a1524-462800aAssociation of kidney disease measures with ischemic versus hemorrhagic strokes: pooled analyses of 4 prospective community-based cohorts.0 aAssociation of kidney disease measures with ischemic versus hemo c2014 Jul a1925-310 v453 a
BACKGROUND AND PURPOSE: Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke.
METHODS: We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression.
RESULTS: Among 29,595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280,549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m2 were 1.30 (95% confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure.
CONCLUSIONS: Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.
10aAged10aAlbuminuria10aBrain Ischemia10aComorbidity10aFemale10aGlomerular Filtration Rate10aHumans10aIntracranial Hemorrhages10aKidney Diseases10aMale10aMiddle Aged10aNetherlands10aProportional Hazards Models10aProspective Studies10aRisk Factors10aStroke10aUnited States1 aMahmoodi, Bakhtawar, K1 aYatsuya, Hiroshi1 aMatsushita, Kunihiro1 aSang, Yinying1 aGottesman, Rebecca, F1 aAstor, Brad, C1 aWoodward, Mark1 aLongstreth, W T1 aPsaty, Bruce, M1 aShlipak, Michael, G1 aFolsom, Aaron, R1 aGansevoort, Ron, T1 aCoresh, Josef uhttps://chs-nhlbi.org/node/6424