Anemia and chronic kidney disease are potential risk factors for mortality in stroke patients: a historic cohort study

Abstract

Background: Chronic kidney disease (CKD) is associated to a higher stroke risk. Anemia is a common consequence of CKD, and is also a possible risk factor for cerebrovascular diseases. The purpose of this study was to examine if anemia and CKD are independent risk factors for mortality after stroke.

Methods: This historic cohort study was based on a stroke registry and included patients treated for a first clinical stroke in the stroke unit of one academic hospital over a three-year period. Mortality predictors comprised demographic characteristics, CKD, glomerular filtration rate (GFR), anemia and other stroke risk factors. GFR was estimated by means of the simplified Modification of Diet in Renal Disease formula. Renal function was assessed according to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification in five groups. A value of hemoglobin < 120 g/L in women and < 130 g/L in men on admission defined anemia. Kaplan-Meier survival curves and Cox models were used to describe and analyze one-year survival.

Results: Among 890 adult stroke patients, the mean (Standard Deviation) calculated GFR was 64.3 (17.8) ml/min/1.73 m2 and 17% had anemia. Eighty-two (10%) patients died during the first year after discharge. Among those, 50 (61%) had K/DOQI CKD stages 3 to 5 and 32 (39%) stages 1 or 2 (p < 0.001). Anemia was associated with an increased risk of death one year after discharge (p < 0.001). After adjustment for other factors, a higher hemoglobin level was independently associated with decreased mortality one year after discharge [hazard ratio (95% CI) 0.98 (0.97-1.00)].

Conclusions: Both CKD and anemia are frequent among stroke patients and are potential risk factors for decreased one-year survival. The inclusion of patients with a first-ever clinical stroke only and the determination of anemia based on one single measure, on admission, constitute limitations to the external validity. We should investigate if an early detection and management of both CKD and anemia could improve survival in stroke patients.

Figure 1

Frequencies of Patients Hospitalised for a First Stroke, by Hemoglobin Level (< 120, 120-140, > 140 g/l), according to K/DOQI CKD Stage.

Figure 2

Kaplan-Meier Survival Curve According to K/DOQI CKD Stage, among Patients Hospitalized for a First Stroke, N = 856 [GFR (ml/min/1.73 m²) ≥90: 59; GFR 60-89: 456; GFR: 30-59: 316; GFR ≤29: 25)].

Figure 3

Kaplan-Meier Survival Curve for Individuals with Hemoglobin Levels of < 120 (102), 120-140 (300) and > 140 (454) g/L, among Patients Hospitalized for a First Stroke, N = 856.