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Meta-Analysis
. 2010 Sep 30:341:c4249.
doi: 10.1136/bmj.c4249.

Low glomerular filtration rate and risk of stroke: meta-analysis

Meng Lee  1 , Jeffrey L Saver, Kuo-Hsuan Chang, Hung-Wei Liao, Shen-Chih Chang, Bruce Ovbiagele
Affiliations
Meta-Analysis

Low glomerular filtration rate and risk of stroke: meta-analysis

Meng Lee et al. BMJ. .

Abstract

Objective: To qualitatively and quantitatively investigate the link between a low estimated glomerular filtration rate (eGFR) at baseline and risk of future stroke.

Design: Systematic review and meta-analysis of prospective studies.

Data sources: PubMed (1966-October 2009) and Embase (1947-October 2009). Selection criteria Inclusion criteria were studies that prospectively collected data within cohort studies or clinical trials, estimated glomerular filtration rate at baseline using the modification of diet in renal disease or Cockcroft-Gault equations, assessed incident stroke, had a follow-up of at least one year, and reported quantitative estimates of multivariate adjusted relative risk and 95% confidence interval for stroke associated with an eGFR of 60-90 ml/min/1.73 m(2) or <60 ml/min/1.73 m(2). Data abstraction Two investigators independently abstracted data from eligible studies. Estimates were combined using a random effects model. Heterogeneity was assessed by P value of χ(2) statistics and I(2). Publication bias was assessed by visual examination of funnel plots.

Results: 21 articles derived from 33 prospective studies: 14 articles assessed eGFR <60 ml/min/1.73 m(2) and seven assessed eGRF at both <60 ml/min/1.73 m(2) and 60-90 ml/min/1.73 m(2) for a total of 284 672 participants (follow-up 3.2-15 years) with 7863 stroke events. Incident stroke risk increased among participants with an eGFR <60 ml/min/1.73 m(2) (relative risk 1.43, 95% confidence interval 1.31 to 1.57; P<0.001) but not among those with an eGFR of 60-90 ml/min/1.73 m(2) (1.07, 0.98 to 1.17; P=0.15). Significant heterogeneity existed between estimates among patients with an eGFR <60 ml/min/1.73 m(2) (P<0.001). In subgroup analyses among participants with an eGFR <60 ml/min/1.73 m(2), heterogeneity was significant in Asians compared with non-Asians (1.96, 1.73 to 2.23 v 1.25, 1.16 to 1.35; P<0.001), and those with an eGFR of 40-60 ml/min/1.73 m(2) v <40 ml/min/1.73 m(2) (1.28, 1.04 to 1.56 v 1.77, 1.32 to 2.38; P<0.01).

Conclusions: A baseline eGFR <60 ml/min/1.73 m(2) was independently related to incident stroke across a variety of participants and study designs. Prompt and appropriate implementation of established strategies for reduction of vascular risk in people with know renal insufficiency may prevent future strokes.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any company for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of study selection
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Fig 2 Risk ratio for association of estimated glomerular filtration rate (eGFR) and risk of stroke in prospective cohort studies. *Subgroups of estimates with eGFR <60 ml/min/1.73 m2. †Subgroups of estimates with eGFR 60-90 ml/min/1.73 m2
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Fig 3 Subgroup analyses for comparison between studies reporting associations of estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 with risk of stroke
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Fig 4 Interaction between estimated glomerular filtration rate (eGFR) and albuminuria, using groups with eGFR >60 ml/min/1.73 m2 without albuminuria as reference
See this image and copyright information in PMC

Comment in

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