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Long-Term Prognosis of Acute Kidney Injury after First Acute Stroke

George Tsagalis^*, Theodore Akrivos^*, Maria Alevizaki, Efstathios Manios, Michael Theodorakis, Antonios Laggouranis^*, and Konstantinos N. Vemmos

^* Renal Unit, "Alexandra" Hospital, and Acute Stroke Unit, Department of Clinical Therapeutics, University of Athens, Athens, Greece

Correspondence: Dr. George Tsagalis, Areos 9, Zip Code 15122, Maroussi-Attikis, Greece. Phone: +302108083275; Fax: +302103381493; E-mail: tsagalis{at}otenet.gr

Background and objectives: Acute kidney injury (AKI) has been associated with increased mortality in a variety of clinical settings. We studied the incidence, predictors, and effect of AKI on long-term overall mortality and cardiovascular events after stroke.

Design, setting, participants, & measurements: This was a prospective outcome study of 2155 patients who sustained an acute first-ever stroke and were followed for 10 yr. Patients were divided in two groups: (1) Those with an acute increase (over 48 h) in serum creatinine 0.3 mg/dl or a percentage increase of 50% and (2) those with a change <0.3 mg/dl, no change at all, or even a reduction.

Results: Twenty-seven percent of patients developed AKI after acute stroke. Stroke severity, baseline estimated GFR, heart failure, and stroke subtype predict the occurrence of AKI. The probability of 10-yr mortality for patients with AKI was 75.9 and 57.7 in the patients without AKI (log rank test 45.0; P = 0.001). When patients with AKI were subdivided into three groups according to AKI severity, the probability of 10-yr mortality increased: 73.7, 86.5, and 89.2 in stages 1, 2, and 3, respectively. In Cox proportional hazard analysis, AKI was an independent predictor of 10-yr mortality (P < 0.01) and for the occurrence of new composite cardiovascular events (P < 0.05) after adjustment for available confounding variables.

Conclusions: AKI after stroke is a powerful and independent predictor of 10-yr mortality and new composite cardiovascular events.