Serdar Tütüncü, Manuel C. Olma, Claudia Kunze, Michael Krämer, Joanna Dietzel, Johannes Schurig, Paula Filser, Waltraud Pfeilschifter, Gerhard Hamann, Thomas G. Büttner, Peter Heuschmann, Paulus Kirchhof, Ulrich Laufs, Darius Günther Nabavi, Joachim Röther, Götz Thomalla, Roland Veltkamp, Kai-Uwe Eckardt, Karl Georg Häusler, Matthias Endres
- Background and purpose: Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods: The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD-EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m2. eGFR dynamics were classified based on two in-hospital values as “stable normal” (≥60 ml/min/1.73 m2), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m2), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m2), and “stable decreased” (<60 ml/min/1.73 m2). The composite endpoint (stroke, major bleeding, myocardial infarction, all-cause death) was assessed after 24 months. We estimated hazard ratios in confounder-adjusted models.
Results: Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m2 at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all-cause death (HR = 3.12, 95% CI = 1.63–5.98).
Conclusions: In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
MetadatenVerfasserangaben: | Serdar TütüncüORCiD, Manuel C. Olma, Claudia KunzeGND, Michael Krämer, Joanna DietzelORCiDGND, Johannes SchurigGND, Paula Filser, Waltraud PfeilschifterORCiDGND, Gerhard HamannORCiDGND, Thomas G. BüttnerGND, Peter HeuschmannGND, Paulus KirchhofORCiDGND, Ulrich LaufsORCiDGND, Darius Günther NabaviGND, Joachim RötherORCiDGND, Götz ThomallaORCiDGND, Roland VeltkampGND, Kai-Uwe EckardtORCiDGND, Karl Georg HäuslerORCiDGND, Matthias EndresORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-639834 |
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DOI: | https://doi.org/10.1111/ene.15431 |
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ISSN: | 1468-1331 |
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Titel des übergeordneten Werkes (Englisch): | European journal of neurology |
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Verlag: | Wiley-Blackwell |
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Verlagsort: | Oxford [u.a.] |
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Dokumentart: | Wissenschaftlicher Artikel |
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Sprache: | Englisch |
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Datum der Veröffentlichung (online): | 02.06.2022 |
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Datum der Erstveröffentlichung: | 02.06.2022 |
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Veröffentlichende Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Beteiligte Körperschaft: | MonDAFIS Investigators |
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Datum der Freischaltung: | 02.06.2023 |
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Freies Schlagwort / Tag: | kidney function; prognosis; stroke |
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Jahrgang: | 29 |
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Ausgabe / Heft: | 9 |
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Seitenzahl: | 9 |
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Erste Seite: | 2716 |
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Letzte Seite: | 2724 |
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Bemerkung: | The MonDAFIS study was an investigator-initiated, prospective, randomized, multicenter study sponsored by Charité–Universitätsmedizin Berlin, Germany and supported by an unrestricted research grant from Bayer Vital, Leverkusen, Germany to Charité–Universitätsmedizin Berlin, German |
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Bemerkung: | Open Access funding enabled and organized by Projekt DEAL. |
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Institute: | Medizin |
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DDC-Klassifikation: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Lizenz (Deutsch): | Creative Commons - CC BY-NC-ND - Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International |
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