Ankle-Brachial Index as a Predictor of Long Term Post-Stroke Renal Outcome
Tsung-Lin Lee, MD 1 , Yu-Ming Chang, MD 1 , Pi-Shan Sung, MD 1 ,
1 National Cheng Kung University Hospital
Pi-Shan Sung , MD
National Cheng Kung University Hospital
The presence of chronic kidney disease (CKD) after stroke may be associated with worse long term renal outcomes. The ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) can also be good predictors for chronic kidney disease (CKD) or cerebro-cardio-vascular diseases (CVD) in Western populations. The aim of our study was to show the correlations between post-stroke renal dysfunction, ABI, and baPWV in the Taiwanese population.
MATERIAL and METHOD:
This retrospective cohort study was conducted between July 1, 2016, and December 31, 2017, in a tertiary referral center (Taiwan). We enrolled 957 participants who aged 20-99 with history of recent cerebral ischemic stroke. Renal outcomes were compared among participants grouped according to baseline ABI (1.00~1.40, 0.91~0.99, and 0.90) and baPWV (≥ 14 and < 14). We applied two methods including for different renal outcomes estimated by (1) a group-based trajectory model (GBTM), used to analyze post-stroke renal function trajectory (2) a group-based survival analysis with a 30% decline in eGFR or doubling of serum creatinine as renal outcome.
In the GBTM, the patients were grouped according to their post-stroke renal function trajectory into low, intermediate, and high performance (LP, IP, and HP). The lower ABI group (ABI 0.90) was independently related to being in the LP group (adjusted odds ratio [aOR], 2.40; 95% CI, 1.16-4.95; p = 0.019) after adjustment for the conventional risk factors. In the survival analysis, the lower ABI group was associated with increased risks of ≥ 30% decline in eGFR (adjusted hazard ratio [aHR], 2.28; 95% CI, 1.29-4.05; p = 0.005) and doubling of serum creatinine (aHR, 4.01; 95% CI, 1.93-8.34; p < 0.001). However, the baPWV groups did not have a statistically significant relationship with any of the renal outcomes.
Our findings illustrated that patients with post-stroke CKD may experience the trend of renal decline, and ABI measurements and old age can be a powerful predictor of long term renal outcome.