Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study

Smyth A 1 , Judge C 1 , Wang X 2 , Pare G 1 , Rangarajan S 1 , Canavan M 3 Show all authors , Chin SL 1 , Al-Hussain F 4 , Yusufali AM 5 , Elsayed A 6 , Damasceno A 7 , Avezum A 8 , Czlonkowska A 9 , Rosengren A 10 , Dans AL 11 , Oguz A 12 , Mondo C 13 , Weimar C 14 , Ryglewicz D 15 , Xavier D 16 , Lanas F 17 , Malaga G 18 , Hankey GJ 19 , Iversen HK 20 , Zhang H 2 , Yusoff K 21 , Pogosova N 22 , Lopez-Jamarillo P 23 , Langhorne P 24 , Diaz R 25 , Oveisgharan S 26 , Yusuf S 1 , O'Donnell M 1 , INTERSTROKE investigators

Affiliations 

  • 1 Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
  • 2 Beijing Hypertension League Institute, Beijing, China
  • 3 HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland
  • 4 King Saud University, Riyadh, Saudi Arabia
  • 5 Dubai Health Authority, Dubai Medical College, Dubai, United Arab Emirates
  • 6 Alzaeim Alazhari University, Khartoum North, Sudan
  • 7 Eduardo Mondlane University, Maputo, Mozambique
  • 8 Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
  • 9 Institute of Psychiatry and Neurology, Warsaw, Poland
  • 10 Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 11 College of Medicine, University of Philippines, Manila, Philippines
  • 12 Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
  • 13 Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
  • 14 Department of Neurology, University Hospital, Essen, Germany
  • 15 Military Institute of Aviation Medicine, Warsaw, Poland
  • 16 St John's Medical College and Research Institute, Bangalore, India
  • 17 Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
  • 18 Universidad Peruana Cayetano Heredia, Lima, Peru
  • 19 School of Medicine and Pharmacology, The University of Western Australia, Perth, Washington, Australia
  • 20 Stroke Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  • 21 Universiti Teknologi MARA, Selayang, Selangor, Malaysia, UCSI University, Cheras, Kuala Lumpur, Malaysia
  • 22 National Medical Research Center of Cardiology, Moscow, Russian Federation
  • 23 Instituto de Investigaciones FOSCAL, Escuela de Medicina, Universidad de Santander, Bucaramanga, Colombia
  • 24 Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
  • 25 Estudios Clinicos Latinoamerica, Rosario, Argentina
  • 26 Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, Illinois, USA
Neuroepidemiology, 2021;55(3):206-215.
PMID: 33951632 DOI: 10.1159/000515239

Abstract

BACKGROUND: Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association.

AIMS: We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations.

METHODS: INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke.

RESULTS: Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24-1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35-1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17-1.42) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50-3.54 for death within 1 month).

CONCLUSION: Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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