A retrospective study of renal dysfunction in acute stroke: incidence, impact and outcomes

Arnold, Julia Jacqueline ORCID: 0000-0003-0117-2640 (2020). A retrospective study of renal dysfunction in acute stroke: incidence, impact and outcomes. University of Birmingham. Ph.D.

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Abstract

Stroke is a leading cause of death and neurological disability worldwide. Chronic kidney disease (CKD) is associated with an increased risk of stroke. Conversely, CKD confers worse outcomes following a stroke, with the highest mortality seen in end-stage renal disease. In comparison, the relationship between AKI and stroke is not well described, with a lack of UK data. In this single-centre, retrospective observational study of hospitalisations with acute stroke, I sought to determine the incidence of renal dysfunction and its impact on outcomes. AKI incidence was determined using preadmission serum creatinine (SCr) as ‘baseline’ renal function, compared with 4 surrogate methods. AKI was common, with an overall incidence of 20%, and was associated with increased 30-day and 1-year mortality using all AKI methods. Admission SCr most closely agreed with preadmission SCr but all surrogate methods exhibited bi-directional misclassification of AKI. CKD prevalence was high (over 30%) and was associated with increased mortality in univariable analyses. CKD patients underwent fewer imaging modalities and thrombectomy, possibly suggesting the presence of ‘renalism’. Contrast exposure was not found to be a risk factor for AKI. Vascular calcification and carotid artery disease were univariably associated with CKD. Multi-centre studies are needed to confirm the findings.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
Supervisor(s):
Supervisor(s)EmailORCID
Ferro, CharlesUNSPECIFIEDUNSPECIFIED
Gill, ParamjitUNSPECIFIEDUNSPECIFIED
Cockwell, PaulUNSPECIFIEDUNSPECIFIED
Licence: All rights reserved
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: Institute of Applied Health Research
Funders: None/not applicable
Subjects: R Medicine > RZ Other systems of medicine
URI: http://etheses.bham.ac.uk/id/eprint/10895

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