Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission

Nada El Husseini, Gregg C. Fonarow, Eric E. Smith, Christine Ju, Shubin Sheng, Lee H. Schwamm, Adrian F. Hernandez, Phillip Schulte, Ying Xian, Larry B. Goldstein

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Purpose- Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods- In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results- Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66-2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49-2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95-2.26 and HR, 2.55; 95% CI, 2.44-2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90-2.18 and HR, 2.46; 95% CI, 2.36-2.56, respectively). Conclusions- Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.

Original languageEnglish (US)
Pages (from-to)2896-2903
Number of pages8
JournalStroke
Volume49
Issue number12
DOIs
StatePublished - Dec 1 2018

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Patient Readmission
Glomerular Filtration Rate
Kidney
Mortality
Dialysis
Stroke
Fee-for-Service Plans
Diagnosis-Related Groups
Kidney Diseases
Medicare
Proportional Hazards Models
Hospitalization
Cohort Studies
Outcome Assessment (Health Care)
Guidelines

Keywords

  • kidney diseases
  • Medicare
  • mortality
  • stroke

ASJC Scopus subject areas

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

Cite this

El Husseini, N., Fonarow, G. C., Smith, E. E., Ju, C., Sheng, S., Schwamm, L. H., ... Goldstein, L. B. (2018). Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. Stroke, 49(12), 2896-2903. https://doi.org/10.1161/STROKEAHA.118.022011

Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. / El Husseini, Nada; Fonarow, Gregg C.; Smith, Eric E.; Ju, Christine; Sheng, Shubin; Schwamm, Lee H.; Hernandez, Adrian F.; Schulte, Phillip; Xian, Ying; Goldstein, Larry B.

In: Stroke, Vol. 49, No. 12, 01.12.2018, p. 2896-2903.

Research output: Contribution to journalArticle

El Husseini, N, Fonarow, GC, Smith, EE, Ju, C, Sheng, S, Schwamm, LH, Hernandez, AF, Schulte, P, Xian, Y & Goldstein, LB 2018, 'Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission', Stroke, vol. 49, no. 12, pp. 2896-2903. https://doi.org/10.1161/STROKEAHA.118.022011
El Husseini N, Fonarow GC, Smith EE, Ju C, Sheng S, Schwamm LH et al. Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. Stroke. 2018 Dec 1;49(12):2896-2903. https://doi.org/10.1161/STROKEAHA.118.022011
El Husseini, Nada ; Fonarow, Gregg C. ; Smith, Eric E. ; Ju, Christine ; Sheng, Shubin ; Schwamm, Lee H. ; Hernandez, Adrian F. ; Schulte, Phillip ; Xian, Ying ; Goldstein, Larry B. / Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. In: Stroke. 2018 ; Vol. 49, No. 12. pp. 2896-2903.
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abstract = "Background and Purpose- Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods- In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results- Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6{\%} women, 79.8{\%} white), 48.8{\%} had an eGFR ≥60, 26.5{\%} an eGFR 45 to 59, 16.3{\%} an eGFR 30 to 44, 5.1{\%} an eGFR 15 to 29, 0.6{\%} an eGFR <15 without dialysis, and 2.8{\%} were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95{\%} CI, 1.66-2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95{\%} CI, 2.49-2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95{\%} CI, 1.95-2.26 and HR, 2.55; 95{\%} CI, 2.44-2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95{\%} CI, 1.90-2.18 and HR, 2.46; 95{\%} CI, 2.36-2.56, respectively). Conclusions- Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.",
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T1 - Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission

AU - El Husseini, Nada

AU - Fonarow, Gregg C.

AU - Smith, Eric E.

AU - Ju, Christine

AU - Sheng, Shubin

AU - Schwamm, Lee H.

AU - Hernandez, Adrian F.

AU - Schulte, Phillip

AU - Xian, Ying

AU - Goldstein, Larry B.

PY - 2018/12/1

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N2 - Background and Purpose- Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods- In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results- Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66-2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49-2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95-2.26 and HR, 2.55; 95% CI, 2.44-2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90-2.18 and HR, 2.46; 95% CI, 2.36-2.56, respectively). Conclusions- Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.

AB - Background and Purpose- Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods- In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results- Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66-2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49-2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95-2.26 and HR, 2.55; 95% CI, 2.44-2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90-2.18 and HR, 2.46; 95% CI, 2.36-2.56, respectively). Conclusions- Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.

KW - kidney diseases

KW - Medicare

KW - mortality

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