Stroke severity and prognosis in patients on the brink of end-stage chronic kidney disease: K-PLUS registry

Background and purpose: The association between chronic kidney disease (CKD) grade and stroke severity or prognosis is still controversial. We investigated the relationship between CKD stage and stroke severity on admission and its influence on prognosis. Methods: Using a regional stroke registry, the clinical characteristics of acute ischemic stroke patients were investigated in each CKD stage (G1-G5). The relationship between CKD stage and the National Institutes of Health Stroke Scale (NIHSS) score was examined in stratified analyses under the presence or absence of various factors. Multiple logistic regression analyses to identify predictors for an unfavorable prognosis or death were performed. Results: Of 10,104 patients, 1,056 (10 %) were CKD stage G1, 3,797 (38 %) were stage G2, 4,137 (41 %) were stage G3, 678 (7 %) were stage G4, and 436 (4 %) were stage G5. The NIHSS score was the highest in patients with stage G4 (median, 10; interquartile range, 4-22), compared to those with G1 (3; 1-8), G2 (3; 2-9), G3 (6; 2-16), and G5 (5; 2-14). Similar results were obtained on multiple logistic regression analysis including potential confounders. As to outcome at discharge, a modified Rankin Scale score of >= 3 was more frequently observed in stage G4 patients. However, the independent relationships diminished after multiple logistic regression analyses including stroke severity on admission as an independent variable. Conclusion: Stroke severity on admission was the highest in patients with CKD stage G4 compared to the other stages, which was possibly related to an unfavorable prognosis and mortality.