Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry
Background The impact of long‐term renal function change on stroke outcomes remains unclear. This study used the CNSR‐III (Third China National Stroke Registry) cohort to determine whether changes in estimated glomerular filtration rate based on creatinine and cystatin C (eGFRCr+CysC) during the fir...
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Wiley
2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037579 |
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| author | Yin Zhang Yuesong Pan Hongyi Yan Xia Meng Jinxi Lin Mengxing Wang Hao Li Qin Xu Pan Chen Anxin Wang Yilun Zhou Yongjun Wang |
| author_facet | Yin Zhang Yuesong Pan Hongyi Yan Xia Meng Jinxi Lin Mengxing Wang Hao Li Qin Xu Pan Chen Anxin Wang Yilun Zhou Yongjun Wang |
| author_sort | Yin Zhang |
| collection | DOAJ |
| description | Background The impact of long‐term renal function change on stroke outcomes remains unclear. This study used the CNSR‐III (Third China National Stroke Registry) cohort to determine whether changes in estimated glomerular filtration rate based on creatinine and cystatin C (eGFRCr+CysC) during the first year post stroke were associated with 5‐year stroke outcomes. Methods and Results We included 4270 patients with centrally tested serum creatinine and cystatin C at admission and 1 year post admission and evaluated 5‐year follow‐up data. Patients were stratified into quintiles based on the 1‐year changes in eGFR. The primary outcomes included all‐cause mortality, stroke disability, and stroke recurrence. In patients with acute ischemic stroke, the mean baseline eGFRCr+CysC was 88.6±22.6 mL/min per 1.73 m2, which decreased by 5.6% to 83.6±20.7 mL/min per 1.73 m2 at 1 year. Compared with patients with relatively stable eGFRCr+CysC (Q3), those with decreased eGFRCr+CysC (Q1) exhibited significantly increased adjusted risk of death (hazard ratio [HR], 1.96 [95% CI, 1.27–3.04], P=0.003) and those with increased eGFRCr+CysC (Q5) exhibited borderline significance (HR, 1.51 [95% CI, 0.94–2.42], P=0.09), after adjusting for confounders, including baseline eGFRCr+CysC and albumin‐to‐creatinine ratio. Patients with a significant decrease (odds ratio [OR], 1.74 [95% CI, 1.25–2.42], P=0.001) or increase (OR, 1.51 [95% CI, 1.06–2.15], P=0.02) in eGFRCr+CysC also experienced a higher risk of disability. Conclusions Both the decline and increase in eGFRCr+CysC levels in the first year post stroke were independently associated with all‐cause mortality and stroke disability. These findings indicate that monitoring eGFRCr+CysC changes could be important for predicting long‐term outcomes and informing poststroke care strategies. |
| format | Article |
| id | doaj-art-ba8885b36eb24a3d8e7e65ca98126543 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-ba8885b36eb24a3d8e7e65ca981265432025-08-20T03:24:32ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.124.037579Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke RegistryYin Zhang0Yuesong Pan1Hongyi Yan2Xia Meng3Jinxi Lin4Mengxing Wang5Hao Li6Qin Xu7Pan Chen8Anxin Wang9Yilun Zhou10Yongjun Wang11Department of Nephrology Beijing Tiantan Hospital, Capital Medical University Beijing ChinaDepartment of Epidemiology and Health Statistics, School of Public Health Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaDepartment of Nephrology Beijing Tiantan Hospital, Capital Medical University Beijing ChinaDepartment of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing ChinaBackground The impact of long‐term renal function change on stroke outcomes remains unclear. This study used the CNSR‐III (Third China National Stroke Registry) cohort to determine whether changes in estimated glomerular filtration rate based on creatinine and cystatin C (eGFRCr+CysC) during the first year post stroke were associated with 5‐year stroke outcomes. Methods and Results We included 4270 patients with centrally tested serum creatinine and cystatin C at admission and 1 year post admission and evaluated 5‐year follow‐up data. Patients were stratified into quintiles based on the 1‐year changes in eGFR. The primary outcomes included all‐cause mortality, stroke disability, and stroke recurrence. In patients with acute ischemic stroke, the mean baseline eGFRCr+CysC was 88.6±22.6 mL/min per 1.73 m2, which decreased by 5.6% to 83.6±20.7 mL/min per 1.73 m2 at 1 year. Compared with patients with relatively stable eGFRCr+CysC (Q3), those with decreased eGFRCr+CysC (Q1) exhibited significantly increased adjusted risk of death (hazard ratio [HR], 1.96 [95% CI, 1.27–3.04], P=0.003) and those with increased eGFRCr+CysC (Q5) exhibited borderline significance (HR, 1.51 [95% CI, 0.94–2.42], P=0.09), after adjusting for confounders, including baseline eGFRCr+CysC and albumin‐to‐creatinine ratio. Patients with a significant decrease (odds ratio [OR], 1.74 [95% CI, 1.25–2.42], P=0.001) or increase (OR, 1.51 [95% CI, 1.06–2.15], P=0.02) in eGFRCr+CysC also experienced a higher risk of disability. Conclusions Both the decline and increase in eGFRCr+CysC levels in the first year post stroke were independently associated with all‐cause mortality and stroke disability. These findings indicate that monitoring eGFRCr+CysC changes could be important for predicting long‐term outcomes and informing poststroke care strategies.https://www.ahajournals.org/doi/10.1161/JAHA.124.037579acute ischemic stroke outcomecreatininecystatin CeGFR change |
| spellingShingle | Yin Zhang Yuesong Pan Hongyi Yan Xia Meng Jinxi Lin Mengxing Wang Hao Li Qin Xu Pan Chen Anxin Wang Yilun Zhou Yongjun Wang Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute ischemic stroke outcome creatinine cystatin C eGFR change |
| title | Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry |
| title_full | Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry |
| title_fullStr | Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry |
| title_full_unstemmed | Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry |
| title_short | Prognostic Impact of 1‐Year Changes in Creatinine‐ and Cystatin C‐Based Estimated Glomerular Filtration Rate After Stroke on 5‐Year Outcomes: Insights From the Third China National Stroke Registry |
| title_sort | prognostic impact of 1 year changes in creatinine and cystatin c based estimated glomerular filtration rate after stroke on 5 year outcomes insights from the third china national stroke registry |
| topic | acute ischemic stroke outcome creatinine cystatin C eGFR change |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037579 |
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