Reduced glomerular filtration rate and risk of stroke: A nationwide cohort study in South Korea

Chang Mo Oh, Sung Keun Park, Ju Young Jung, Joong Myung Choi, Eunhee Ha, Eun Young Lee, Jung Wook Kim, Hee Yong Kang, Hong Jun Yang, Jae Hong Ryoo

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Aims: Although chronic kidney disease is recognized as an independent risk factor for cerebrovascular disease, its association with hemorrhagic and ischemic stroke remains controversial. Methods: We conducted a retrospective cohort study using the National Health Insurance Service-National Sample Cohort, which is representative of the Korean population. A total of 195,772 Koreans who were not diagnosed with stroke before 2009 were included in this study from 2009 to 2013. The eGFR was divided into six categories (≥ 90, 75–89, 60–74, 45–59, 30–44, <30 mL/min/1.73 m2). The Kaplan–Meier plot was illus-trated to compare the incidence of stroke. Cox proportional hazard model was used to estimate the hazard ratio (HR) of eGFR for risk of ischemic and hemorrhagic stroke by sex. Results: During an average of 4.36 years of follow-up period, 2,236 and 668 people were diagnosed with newly ischemic and hemorrhagic stroke, respectively. Age-adjusted incidence rate for ischemic stroke among people with eGFR <45 mL/min/1.73 m2 was higher than those with eGFR ≥ 90 mL/min/1.73 m2, whereas that for hemorrhagic stroke among people with eGFR ≥ 90 mL/min/1.73 m2 was higher than those with eGFR <45 mL/min/1.73 m2. After adjusting for multiple covariates, the adjusted HR for ischemic stroke increased with decreasing eGFR in men (p for trend <0.001), but not in women (p for trend =0.48). On the other hand, there was no significant relationship between eGFR and risk of hemorrhagic stroke in both men and women. Conclusions: Reduced glomerular filtration rate less than 45 mL/min/1.73 m2 was associated with an increased risk of ischemic stroke, especially in men.

Original languageEnglish
Pages (from-to)928-941
Number of pages14
JournalJournal of Atherosclerosis and Thrombosis
Volume28
Issue number9
DOIs
StatePublished - 2021

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea in 2019 (grant number: 2019R1G1A1003680). The funding organization had no role in the design or conduct of this research.

Publisher Copyright:
© 2021 Japan Atherosclerosis Society.

Keywords

  • Cerebral hemorrhage
  • Cerebral infarction
  • Chronic renal insufficiency
  • Glomerular filtration rate
  • Stroke

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