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

被引：70

作者：

Sandsmark, Danielle K. ^{[1
]}

Messe, Steven R. ^{[1
]}

Zhang, Xiaoming ^{[4
]}

Roy, Jason ^{[4
]}

Nessel, Lisa ^{[4
]}

Hamm, Lotuce Lee ^{[5
]}

He, Jiang ^{[6
]}

Horwitz, Edward J. ^{[7
]}

Jaar, Bernard G. ^{[8
]}

Kallem, Radhakrishna R. ^{[2
]}

Kusek, John W. ^{[9
]}

Mohler, Emile R., III ^{[3
]}

Porter, Anna ^{[10
]}

Seliger, Stephen L. ^{[11
]}

Sozio, Stephen M. ^{[12
]}

Townsend, Raymond R. ^{[2
]}

Feldman, Harold I. ^{[4
]}

Kasner, Scott E. ^{[1
]}

机构：

[1] Hosp Univ Penn, Dept Neurol, Dept Med, Philadelphia, PA 19104 USA

[2] Hosp Univ Penn, Renal Electrolyte & Hypertens Div, Dept Med, Philadelphia, PA 19104 USA

[3] Hosp Univ Penn, Div Vasc Med, Dept Med, Philadelphia, PA 19104 USA

[4] Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA

[5] Tulane Univ, Dept Med, New Orleans, LA 70118 USA

[6] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, New Orleans, LA USA

[7] Metrohealth, Dept Med, Cleveland, OH USA

[8] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA

[9] NIDDK, Div Kidney Urol & Hematol Dis, Bethesda, MD USA

[10] Univ Illinois, Dept Nephrol, Chicago, IL USA

[11] Univ Maryland, Dept Med, Baltimore, MD 21201 USA

[12] Johns Hopkins Univ, Dept Med, Baltimore, MD USA

来源：

STROKE | 2015年 / 46卷 / 08期

基金：

美国国家卫生研究院;

关键词：

albuminuria; kidney diseases; risk factors; proteinuria; stroke; GLOMERULAR-FILTRATION-RATE; INCIDENT STROKE; CARDIOVASCULAR MORTALITY; ATRIAL-FIBRILLATION; CYSTATIN C; ALL-CAUSE; MICROALBUMINURIA; ALBUMINURIA; ASSOCIATION; METAANALYSIS;

D O I：

10.1161/STROKEAHA.115.009861

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：2075 / 2080

页数：6

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