Incidence of stroke symptoms among adults with chronic kidney disease

Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

Paul Muntner, Suzanne E. Judd, William McClellan, James F Meschia, David G. Warnock, Virginia J. Howard

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background.Reduced glomerular filtration rate and albuminuria are associated with an increased risk for stroke. Their association with stroke symptoms is not known. Methods.The incidence of stroke symptoms was determined in 20386 participants ≥45 years of age in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of a history of stroke, transient ischemic attack and stroke symptoms at baseline. Six stroke symptoms were assessed via telephone interviews at baseline and every 6 months. Participants were followed over a median of 2.1 years (maximum follow-up of 6 years). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation and the albumin-to-creatinine ratio from spot urine samples. Results.The incidence of any stroke symptom (n = 2548 cases) was 10.8, 12.9, 18.2 and 20.7% among participants with an eGFR ≥90, 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, and 10.8, 14.4, 17.0 and 18.8 for participants with albumin-to-creatinine ratios <10, 10-29, 30-299 and ≥300 mg/g, respectively (each P-trend < 0.001). The multivariable-adjusted hazard ratio (95% confidence interval) for any stroke symptom was 1.02 (0.91-1.14), 1.22 (1.01-1.48) and 1.26 (0.98-1.62) for those with an eGFR of 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, versus ≥90 mL/min/1.73m 2 (P-trend = 0.022) and 1.16 (1.03-1.31), 1.29 (1.12-1.50) and 1.11 (0.82-1.49) for those with albumin-to-creatinine ratios of 10-29, 30-299 and ≥300 versus <10 mg/g, respectively (P-trend = 0.005). Conclusions.Reduced eGFR and higher albuminuria levels are associated with an increased risk for incident stroke symptoms.

Original languageEnglish (US)
Pages (from-to)166-173
Number of pages8
JournalNephrology Dialysis Transplantation
Volume27
Issue number1
DOIs
StatePublished - Jan 2012

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Chronic Renal Insufficiency
Stroke
Incidence
Glomerular Filtration Rate
Albumins
Creatinine
Albuminuria
Transient Ischemic Attack
Urine
Confidence Intervals
Interviews

Keywords

  • albuminuria
  • chronic kidney disease
  • stroke
  • stroke symptoms

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Incidence of stroke symptoms among adults with chronic kidney disease : Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. / Muntner, Paul; Judd, Suzanne E.; McClellan, William; Meschia, James F; Warnock, David G.; Howard, Virginia J.

In: Nephrology Dialysis Transplantation, Vol. 27, No. 1, 01.2012, p. 166-173.

Research output: Contribution to journalArticle

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abstract = "Background.Reduced glomerular filtration rate and albuminuria are associated with an increased risk for stroke. Their association with stroke symptoms is not known. Methods.The incidence of stroke symptoms was determined in 20386 participants ≥45 years of age in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of a history of stroke, transient ischemic attack and stroke symptoms at baseline. Six stroke symptoms were assessed via telephone interviews at baseline and every 6 months. Participants were followed over a median of 2.1 years (maximum follow-up of 6 years). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation and the albumin-to-creatinine ratio from spot urine samples. Results.The incidence of any stroke symptom (n = 2548 cases) was 10.8, 12.9, 18.2 and 20.7{\%} among participants with an eGFR ≥90, 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, and 10.8, 14.4, 17.0 and 18.8 for participants with albumin-to-creatinine ratios <10, 10-29, 30-299 and ≥300 mg/g, respectively (each P-trend < 0.001). The multivariable-adjusted hazard ratio (95{\%} confidence interval) for any stroke symptom was 1.02 (0.91-1.14), 1.22 (1.01-1.48) and 1.26 (0.98-1.62) for those with an eGFR of 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, versus ≥90 mL/min/1.73m 2 (P-trend = 0.022) and 1.16 (1.03-1.31), 1.29 (1.12-1.50) and 1.11 (0.82-1.49) for those with albumin-to-creatinine ratios of 10-29, 30-299 and ≥300 versus <10 mg/g, respectively (P-trend = 0.005). Conclusions.Reduced eGFR and higher albuminuria levels are associated with an increased risk for incident stroke symptoms.",
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T1 - Incidence of stroke symptoms among adults with chronic kidney disease

T2 - Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

AU - Muntner, Paul

AU - Judd, Suzanne E.

AU - McClellan, William

AU - Meschia, James F

AU - Warnock, David G.

AU - Howard, Virginia J.

PY - 2012/1

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N2 - Background.Reduced glomerular filtration rate and albuminuria are associated with an increased risk for stroke. Their association with stroke symptoms is not known. Methods.The incidence of stroke symptoms was determined in 20386 participants ≥45 years of age in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of a history of stroke, transient ischemic attack and stroke symptoms at baseline. Six stroke symptoms were assessed via telephone interviews at baseline and every 6 months. Participants were followed over a median of 2.1 years (maximum follow-up of 6 years). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation and the albumin-to-creatinine ratio from spot urine samples. Results.The incidence of any stroke symptom (n = 2548 cases) was 10.8, 12.9, 18.2 and 20.7% among participants with an eGFR ≥90, 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, and 10.8, 14.4, 17.0 and 18.8 for participants with albumin-to-creatinine ratios <10, 10-29, 30-299 and ≥300 mg/g, respectively (each P-trend < 0.001). The multivariable-adjusted hazard ratio (95% confidence interval) for any stroke symptom was 1.02 (0.91-1.14), 1.22 (1.01-1.48) and 1.26 (0.98-1.62) for those with an eGFR of 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, versus ≥90 mL/min/1.73m 2 (P-trend = 0.022) and 1.16 (1.03-1.31), 1.29 (1.12-1.50) and 1.11 (0.82-1.49) for those with albumin-to-creatinine ratios of 10-29, 30-299 and ≥300 versus <10 mg/g, respectively (P-trend = 0.005). Conclusions.Reduced eGFR and higher albuminuria levels are associated with an increased risk for incident stroke symptoms.

AB - Background.Reduced glomerular filtration rate and albuminuria are associated with an increased risk for stroke. Their association with stroke symptoms is not known. Methods.The incidence of stroke symptoms was determined in 20386 participants ≥45 years of age in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of a history of stroke, transient ischemic attack and stroke symptoms at baseline. Six stroke symptoms were assessed via telephone interviews at baseline and every 6 months. Participants were followed over a median of 2.1 years (maximum follow-up of 6 years). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation and the albumin-to-creatinine ratio from spot urine samples. Results.The incidence of any stroke symptom (n = 2548 cases) was 10.8, 12.9, 18.2 and 20.7% among participants with an eGFR ≥90, 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, and 10.8, 14.4, 17.0 and 18.8 for participants with albumin-to-creatinine ratios <10, 10-29, 30-299 and ≥300 mg/g, respectively (each P-trend < 0.001). The multivariable-adjusted hazard ratio (95% confidence interval) for any stroke symptom was 1.02 (0.91-1.14), 1.22 (1.01-1.48) and 1.26 (0.98-1.62) for those with an eGFR of 60-89, 45-59 and <45 mL/min/1.73m 2, respectively, versus ≥90 mL/min/1.73m 2 (P-trend = 0.022) and 1.16 (1.03-1.31), 1.29 (1.12-1.50) and 1.11 (0.82-1.49) for those with albumin-to-creatinine ratios of 10-29, 30-299 and ≥300 versus <10 mg/g, respectively (P-trend = 0.005). Conclusions.Reduced eGFR and higher albuminuria levels are associated with an increased risk for incident stroke symptoms.

KW - albuminuria

KW - chronic kidney disease

KW - stroke

KW - stroke symptoms

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DO - 10.1093/ndt/gfr218

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