Evaluation of Influence of Chronic Kidney Disease and Sodium Disturbances on Clinical Course of Acute and Sub-Acute Stage First-Ever Ischemic Stroke
Anetta Lasek-Bal, Michał Holecki, Bartłomiej Kret, Anna Hawrot-Kawecka, Jan Duława
(Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland)
Med Sci Monit 2014; 20:1389-1394
Chronic kidney disease (CKD) is an independent risk factor for cardiovascular morbidity and mortality. Hyponatremia is the most common electrolyte disturbance encountered in the neurological and neurosurgical intensive care units, and can exacerbate existing neurological deficits. The objective of this study was to observe the influences of chronic kidney disease and sodium disturbances on the clinical course of acute and sub-acute stages of first-ever ischemic stroke.
Material and Methods: 464 patients with previously diagnosed chronic kidney disease (aged 70.42±11.49 years; 250 women) who had experienced their first-ever ischemic stroke were qualified. The following examinations were performed: serum levels of sodium, creatinine, lipids, estimated glomerular filtration rate (eGFR), neurological state on 1st day of stroke (according to National Institutes of Health Stroke Scale), functional state measured with the Rankin scale, (RS) and mortality rate at 1 month after stroke.
Results: The neurological state on 1st day of stroke was worse and the median RS (30 days after stroke) was higher in patients with eGFR ≤60 ml/ (min×1.73). Men with eGFR ≤60 ml had greater neurological deficits and increased mortality within 1 month. In patients with eGFR >60 ml/, male sex was more often associated with worse outcomes at 1 month after ischemic stroke. Hyponatremia was associated with a more severe state in both the acute and sub-acute stages of stroke, with higher incidence of death within 1 month after stroke. Men with hyponatremia had greater neurological deficits on the 1st day and increased mortality within 1 month.
Conclusions: Renal impairment and hyponatremia are associated with worse neurological outcomes in patients in the acute stage of their first-ever stroke and within 1 month after the event. Males with impaired kidney function and hyponatremia have a more severe course in their first-ever ischemic stroke, as well as having increased mortality.
Keywords: Aged, 80 and over, Aged, Brain Ischemia - complications, Creatinine - blood, Female, Glomerular Filtration Rate, Humans, Hyponatremia - complications, Lipids - blood, Male, Middle Aged, Poland, Renal Insufficiency, Chronic - complications, Sodium - blood, Statistics, Nonparametric, Stroke - physiopathology