Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 5;3(3):e000905.
doi: 10.1161/JAHA.114.000905.

Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease

Bruce Ovbiagele  1 , Lee H Schwamm  2 , Eric E Smith  3 , Maria V Grau-Sepulveda  4 , Jeffrey L Saver  5 , Deepak L Bhatt  6 , Adrian F Hernandez  4 , Eric D Peterson  4 , Gregg C Fonarow  7
Affiliations

Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease

Bruce Ovbiagele et al. J Am Heart Assoc. .

Abstract

Background: Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in-hospital prognoses among patients with CKD in the Get With The Guidelines-Stroke (GWTG-Stroke) program

Methods and results: We analyzed 679 827 patients hospitalized with ischemic stroke from 1564 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. Use of 7 predefined ischemic stroke performance measures, composite "defect-free" care compliance, and in-hospital mortality were examined based on glomerular filtration rate (GFR) categorized as a dichotomous (+CKD as <60) or rank-ordered variable: normal (≥ 90), mild (≥ 60 to <90), moderate (≥ 30 to <60), severe (≥ 15 to <30), and kidney failure (<15 or dialysis). There were 236 662 (35%) ischemic stroke patients with CKD. Patients with severe renal dysfunction or failure were significantly less likely to receive guideline-based therapies. Compared with patients with normal kidney function (≥ 90), those with CKD (adjusted OR 0.91 [95% CI: 0.89 to 0.92]), moderate dysfunction (adjusted OR 0.94 [95% CI: 0.92 to 0.97]), severe dysfunction (adjusted OR 0.80 [95% CI: 0.77 to 0.84]), or failure (adjusted OR 0.72 [95% CI: 0.68 to 0.0.76]), were less likely to receive 100% defect-free care measure compliance. Inpatient mortality was higher for patients with CKD (adjusted odds ratio 1.44 [95% CI: 1.40 to 1.47]), and progressively rose with more severe renal dysfunction.

Conclusions: Despite higher in-hospital mortality rates, ischemic stroke patients with CKD, especially those with greater severity of renal dysfunction, were less likely to receive important guideline-recommended therapies.

Keywords: chronic kidney disease; glomerular Filtration Rate; guidelines; ischemic stroke; outcomes; prognosis; quality indicators; renal.

PubMed Disclaimer

References

    1. Lee M, Ovbiagele B. Reno‐cerebrovascular disease: linking the nephron and neuron. Expert Rev Neurother. 2011; 11:241-249. - PubMed
    1. Ovbiagele B. Chronic kidney disease and risk of death during hospitalization for stroke. J Neurol Sci. 2011; 301:46-50. - PubMed
    1. Ani C, Ovbiagele B. Relation of baseline presence and severity of renal disease to long‐term mortality in persons with known stroke. J Neurol Sci. 2010; 288:123-128. - PubMed
    1. Tsagalis G, Akrivos T, Alevizaki M, Manios E, Stamatellopoulos K, Laggouranis A, Vemmos KN. Renal dysfunction in acute stroke: an independent predictor of long‐term all combined vascular events and overall mortality. Nephrol Dial Transplant. 2009; 24:194-200. - PubMed
    1. Lee M, Markovic D, Ovbiagele B. Impact and interaction of low estimated GFR and B vitamin therapy on prognosis among ischemic stroke patients: the Vitamin Intervention for Stroke Prevention (VISP) trial. Am J Kidney Dis. 2013; 62:52-57. - PubMed

Publication types

MeSH terms