CHRONIC KIDNEY DISEASE AND MORTALITY – DATA FROM THE CROATIAN COHORT OF THE ESH STROKE SURVEY

Objective: The aim of this study was to assess the association of chronic kidney disease (CKD) with all-cause and cardiovascular (CV) mortality in patients surviving their first ischemic stroke and enrolled in the Croatian part of the ESH Stroke Survey. Design and method: The cohort consisted of 292 consecutive patients (171 m, mean age 64 y) admitted to UHC Zagreb and diagnosed with ischemic stroke between 2011–2014. The mean follow-up period was 6.3 years. Data were collected from medical records. CKD was defined as eGFR < 60 ml/min/1,73m2 (CKD-Epi). Mortality data were obtained from the Croatian National Public Health database. Results: Hypertension, smoking, diabetes, dyslipidemia and atrial fibrillation were diagnosed in 75%, 27.3%, 24.5%, 17.4%, 11.7%, respectively. CKD was detected in 51.7% (men vs women 41% vs 67%; p = 0.000001). CKD stages 1, 2, 3a, 3b, 4 and 5 were diagnosed in 6.8%, 41%, 31.8%, 14.7%, 3.4% and 1.7%, respectively. During the follow-up period, 91 patients (31.1%) died. The major cause of death was stroke (60.4%), followed by other causes (15.3%), cancer (14.2%) and CV diseases (9.8%). All-cause mortality was significantly higher in the CKD than in the non-CKD group (37.1% vs 21.2%: p = 0.0000) as were stroke mortality (24.6% vs. 15.1%; p = 0.0049) and composite CV mortality (stroke, coronary heart disease, heart failure) (42.7% vs 16.2%; p = 0.0015). In a linear multivariate regression model, age was the most important determinant of death (B −0.011 SE 0.202; Beta −0.27; p < 0.000000) followed by CKD (B −0.101 SE 0.058 Beta −0.109; p = 0.085). In a model including age, gender, systolic BP at the time of stroke and CKD (R2 = 0.323), the impact of CKD on mortality risk was 9%. Conclusions: CKD is highly prevalent in patients with ischemic stroke. It is associated with higher all-cause and CV mortality. CKD should be considered a risk and a prognostic factor in patients with ischemic stroke.