Association of kidney disease measures with ischemic versus hemorrhagic strokes: Pooled analyses of 4 prospective community-based cohorts

Bakhtawar K. Mahmoodi, Hiroshi Yatsuya, Kunihiro Matsushita, Yinying Sang, Rebecca F. Gottesman, Brad C. Astor, Mark Woodward, W. T. Longstreth, Bruce M. Psaty, Michael G. Shlipak, Aaron R. Folsom, Ron T. Gansevoort, Josef Coresh

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Abstract

BACKGROUND AND PURPOSE - : Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke. METHODS - : We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression. RESULTS - : Among 29 595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280 549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m were 1.30 (95% confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure. CONCLUSIONS - : Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.

Original languageEnglish
Pages (from-to)1925-1931
Number of pages7
JournalStroke
Volume45
Issue number7
DOIs
Publication statusPublished - 01-01-2014

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Kidney Diseases
Stroke
Glomerular Filtration Rate
Creatinine
Albuminuria
Albumins
Blood Pressure
Cystatin C
Netherlands

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Mahmoodi, Bakhtawar K. ; Yatsuya, Hiroshi ; Matsushita, Kunihiro ; Sang, Yinying ; Gottesman, Rebecca F. ; Astor, Brad C. ; Woodward, Mark ; Longstreth, W. T. ; Psaty, Bruce M. ; Shlipak, Michael G. ; Folsom, Aaron R. ; Gansevoort, Ron T. ; Coresh, Josef. / Association of kidney disease measures with ischemic versus hemorrhagic strokes : Pooled analyses of 4 prospective community-based cohorts. In: Stroke. 2014 ; Vol. 45, No. 7. pp. 1925-1931.
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title = "Association of kidney disease measures with ischemic versus hemorrhagic strokes: Pooled analyses of 4 prospective community-based cohorts",
abstract = "BACKGROUND AND PURPOSE - : Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke. METHODS - : We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression. RESULTS - : Among 29 595 participants (mean age, 61 [SD 12.5] years; 46{\%} men; 17{\%} black), 1261 developed stroke (12{\%} hemorrhagic) during 280 549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m were 1.30 (95{\%} confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure. CONCLUSIONS - : Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.",
author = "Mahmoodi, {Bakhtawar K.} and Hiroshi Yatsuya and Kunihiro Matsushita and Yinying Sang and Gottesman, {Rebecca F.} and Astor, {Brad C.} and Mark Woodward and Longstreth, {W. T.} and Psaty, {Bruce M.} and Shlipak, {Michael G.} and Folsom, {Aaron R.} and Gansevoort, {Ron T.} and Josef Coresh",
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Mahmoodi, BK, Yatsuya, H, Matsushita, K, Sang, Y, Gottesman, RF, Astor, BC, Woodward, M, Longstreth, WT, Psaty, BM, Shlipak, MG, Folsom, AR, Gansevoort, RT & Coresh, J 2014, 'Association of kidney disease measures with ischemic versus hemorrhagic strokes: Pooled analyses of 4 prospective community-based cohorts', Stroke, vol. 45, no. 7, pp. 1925-1931. https://doi.org/10.1161/STROKEAHA.114.004900

Association of kidney disease measures with ischemic versus hemorrhagic strokes : Pooled analyses of 4 prospective community-based cohorts. / Mahmoodi, Bakhtawar K.; Yatsuya, Hiroshi; Matsushita, Kunihiro; Sang, Yinying; Gottesman, Rebecca F.; Astor, Brad C.; Woodward, Mark; Longstreth, W. T.; Psaty, Bruce M.; Shlipak, Michael G.; Folsom, Aaron R.; Gansevoort, Ron T.; Coresh, Josef.

In: Stroke, Vol. 45, No. 7, 01.01.2014, p. 1925-1931.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of kidney disease measures with ischemic versus hemorrhagic strokes

T2 - Pooled analyses of 4 prospective community-based cohorts

AU - Mahmoodi, Bakhtawar K.

AU - Yatsuya, Hiroshi

AU - Matsushita, Kunihiro

AU - Sang, Yinying

AU - Gottesman, Rebecca F.

AU - Astor, Brad C.

AU - Woodward, Mark

AU - Longstreth, W. T.

AU - Psaty, Bruce M.

AU - Shlipak, Michael G.

AU - Folsom, Aaron R.

AU - Gansevoort, Ron T.

AU - Coresh, Josef

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND AND PURPOSE - : Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke. METHODS - : We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression. RESULTS - : Among 29 595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280 549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m were 1.30 (95% confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure. CONCLUSIONS - : Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.

AB - BACKGROUND AND PURPOSE - : Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke. METHODS - : We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression. RESULTS - : Among 29 595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280 549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m were 1.30 (95% confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure. CONCLUSIONS - : Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.

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