Proteinuria and clinical outcomes after ischemic stroke

Neurology. 2012 Jun 12;78(24):1909-15. doi: 10.1212/WNL.0b013e318259e110. Epub 2012 May 16.


Objectives: The impact of chronic kidney disease (CKD) on clinical outcomes after acute ischemic stroke is still not fully understood. The aim of the present study was to elucidate how CKD and its components, proteinuria and low estimated glomerular filtration rate (eGFR), affect the clinical outcomes after ischemic stroke.

Methods: The study subjects consisted of 3,778 patients with first-ever ischemic stroke within 24 hours of onset from the Fukuoka Stroke Registry. CKD was defined as proteinuria or low eGFR (<60 mL/min/m(2)) or both. The study outcomes were neurologic deterioration (≥2-point increase in the NIH Stroke Scale during hospitalization), in-hospital mortality, and poor functional outcome (modified Rankin Scale score at discharge of 2 to 6). The effects of CKD, proteinuria, and eGFR on these outcomes were evaluated using a multiple logistic regression analysis.

Results: CKD was diagnosed in 1,320 patients (34.9%). In the multivariate analyses after adjusting for confounding factors, patients with CKD had significantly higher risks of neurologic deterioration, in-hospital mortality, and poor functional outcome (p <0.001 for all). Among the CKD components, a higher urinary protein level was associated with an elevated risk of each outcome (p for trend < 0.001 for all), but no clear relationship between the eGFR level and each outcome was found.

Conclusions: CKD is an important predictor of poor clinical outcomes after acute ischemic stroke. Proteinuria independently contributes to the increased risks of neurologic deterioration, mortality, and poor functional outcome, but the eGFR may not be relevant to these outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / complications*
  • Brain Ischemia / mortality
  • Brain Ischemia / physiopathology
  • Female
  • Glomerular Filtration Rate / physiology
  • Hospital Mortality
  • Humans
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Middle Aged
  • Patient Discharge
  • Predictive Value of Tests
  • Prognosis
  • Proteinuria / complications*
  • Proteinuria / mortality
  • Proteinuria / physiopathology
  • Registries
  • Risk Factors
  • Stroke / complications*
  • Stroke / mortality
  • Stroke / physiopathology