Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration

作者：Jeremy Molad, Kaori Miwa, Philip S. Nash, Gareth Ambler, Jonathan G. Best, Duncan Wilson, Hen Hallevi, Simon Fandler‐Höfler, Sebastian Eppinger, Houwei Du, Rustam Al‐Shahi Salman, Hans Rolf Jäger, Gregory Y.H. Lip, Martina Goeldlin, Morin Beyeler, Philipp Buecke, Marwan El‐Koussy, Heinrich P. Mattle, Leonidas D Panos, Dianne H.K. van Dam-Nolen, Florian Dubost, Jeroen Hendrikse, M. Eline Kooi, Werner H. Mess, Paul J. Nederkoorn, Masayuki Shiozawa, Nicolas Christ, Maximilian Bellut, Sarah Gunkel, Christopher Karayiannis, John Ly, Shaloo Singhal, Lee‐Anne Slater, Young Dae Kim, Tae‐Jin Song, Keon-Joo Lee, Jae‐Sung Lim, Hideo Hara, Masashi Nishihara, Jun Tanaka, Masaaki Yoshikawa, Derya Selçuk Demirelli, Zeynep Tanrıverdi, Ender Uysal, Shelagh B. Coutts, Francesca M. Chappell, Stephen Makin, Henry Ka‐Fung Mak, Kay Cheong Teo, Debbie Yuen Kwun Wong, Lisa Hert, Marta Kubacka, Philippe Lyrer, Alexandros A. Polymeris, Benjamin Wagner, Annaelle Zietz, Jill Abrigo, Cyrus Cheng, Chiu‐Wing Winnie Chu, Thomas Leung, Suk Fung Tsang, Brian Yiu, David Seiffge, Urs Fischer, Simon Jung, Christian Enzinger, Thomas Gattringer, Daniel Bos, Ḱazunori Toyoda, Felix Fluri, Thanh G. Phan, Velandai Srikanth, Ji Hoe Heo, Hee‐Joon Bae, Yusuke Yakushiji, Dilek Neci̇oğlu Örken, Eric E. Smith, Joanna M. Wardlaw, Kui Kai Lau, Stefan T. Engelter, Nils Peters, Yannie Soo, David C. Wheeler, Robert Simister, Natan M. Bornstein, David J. Werring, Einor Ben Assayag, Masatoshi Koga · 发表于：Journal of Neurology Neurosurgery & Psychiatry · 年份：2025 · DOI：10.1136/jnnp-2024-335110 · 被引用次数：5 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Dialysis and Renal Disease Management、Acute Ischemic Stroke Management

Background Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity. Methods We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 . Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity. Results 11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)...