Proteinuria, but Not eGFR, Predicts Stroke Risk in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort Study.

Abstract

BACKGROUND AND PURPOSE:

Chronic kidney disease is associated with an increased risk of cardiovascular events. However, the impact of chronic kidney disease on cerebrovascular disease is less well understood. We hypothesized that renal function severity would be predictive of stroke risk, independent of other vascular risk factors.

METHODS:

The study population included 3939 subjects enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a prospective observational cohort. Stroke events were reported by participants and adjudicated by 2 vascular neurologists. Cox proportional hazard models were used to compare measures of baseline renal function with stroke events. Multivariable analysis was performed to adjust for key covariates.

RESULTS:

In 3939 subjects, 143 new stroke events (0.62 events per 100 person-years) occurred over a mean follow-up of 6.4 years. Stroke risk was increased in subjects who had worse baseline measurements of renal function (estimated glomerular filtration rate and total proteinuria or albuminuria). When adjusted for variables known to influence stroke risk, total proteinuria or albuminuria, but not estimated glomerular filtration rate, were associated with an increased risk of stroke. Treatment with blockers of the renin-angiotensin system did not decrease stroke risk in individuals with albuminuria.

CONCLUSIONS:

Proteinuria and albuminuria are better predictors of stroke risk in patients with chronic kidney disease than estimated glomerular filtration rate. The impact of therapies targeting proteinuria/albuminuria in individuals with chronic kidney disease on stroke prevention warrants further investigation.

• Authors: Danielle K Sandsmark, Steven R Messé, Xiaoming Zhang, Jason Roy, Lisa Nessel, Lotuce Lee Hamm, Jiang He, Edward J Horwitz, Bernard G Jaar, Radhakrishna R Kallem, John W Kusek, Emile R Mohler 3rd, Anna Porter, Stephen L Seliger, Stephen M Sozio, Raymond R Townsend, Harold I Feldman, Scott E Kasner, CRIC Study Investigators
• Journal: Stroke (Stroke) Vol. 46 Issue 8 Pg. 2075-80 (Aug 2015) ISSN: 1524-4628 [Electronic] United States
• PMID: 26130097 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Heart Association, Inc.

Topics

• Aged
• Cohort Studies
• Female
• Glomerular Filtration Rate (physiology)
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Proteinuria (diagnosis, epidemiology, metabolism)
• Renal Insufficiency, Chronic (diagnosis, epidemiology, metabolism)
• Risk Factors
• Stroke (diagnosis, epidemiology, metabolism)