Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients
Background: The association between changes in estimated glomerular filtration rate (eGFR) over time and the risk of stroke remains inconclusive. We aimed to evaluate the relation of eGFR change during the China Stroke Primary Prevention Trial (CSPPT) with the risk of first stroke during the subsequ...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Japan Epidemiological Association
2023-03-01
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| Series: | Journal of Epidemiology |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/jea/33/3/33_JE20210242/_pdf |
| _version_ | 1797851704552587264 |
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| author | Panpan He Huan Li Zhuxian Zhang Yuanyuan Zhang Tengfei Lin Yun Song Lishun Liu Min Liang Jing Nie Binyan Wang Yong Huo Fan Fan Hou Xiping Xu Xianhui Qin |
| author_facet | Panpan He Huan Li Zhuxian Zhang Yuanyuan Zhang Tengfei Lin Yun Song Lishun Liu Min Liang Jing Nie Binyan Wang Yong Huo Fan Fan Hou Xiping Xu Xianhui Qin |
| author_sort | Panpan He |
| collection | DOAJ |
| description | Background: The association between changes in estimated glomerular filtration rate (eGFR) over time and the risk of stroke remains inconclusive. We aimed to evaluate the relation of eGFR change during the China Stroke Primary Prevention Trial (CSPPT) with the risk of first stroke during the subsequent post-trial follow-up. Methods: A total of 11,742 hypertensive participants with two eGFR measurements (median measure interval, 4.4; interquartile range, 4.2–4.6 years) and without a history of stroke from the CSPPT were included in this analysis. Results: Over a median post-trial follow-up of 4.4 years, 729 first strokes were identified, of which 635 were ischemic, 88 were hemorrhagic, and 6 were uncertain types of strokes. Compared with those with 1 to <2% per year increase in eGFR (with the lowest stroke risk), those with an increase in eGFR of ≥4% per year had significantly increased risks of first stroke (adjusted hazard ratio [HR] 1.96; 95% confidence interval [CI], 1.10–3.50) and first ischemic stroke (adjusted HR 2.14; 95% CI, 1.17–3.90). Similarly, those with a decline in eGFR of ≥5% per year also had significantly increased first stroke (adjusted HR 2.13; 95% CI, 1.37–3.31) and first ischemic stroke (adjusted HR 1.89; 95% CI, 1.19–3.02) risk. However, there was no significant association between eGFR change and first hemorrhagic stroke. A similar result was found when the change in eGFR was quantified as an absolute annual change. Conclusion: In Chinese hypertensive patients, both the decline and increase of eGFR levels were independently associated with the risks of first stroke or first ischemic stroke. |
| first_indexed | 2024-04-09T19:22:09Z |
| format | Article |
| id | doaj.art-40e1c132e0464af3b63684318f2533f4 |
| institution | Directory Open Access Journal |
| issn | 0917-5040 1349-9092 |
| language | English |
| last_indexed | 2024-04-09T19:22:09Z |
| publishDate | 2023-03-01 |
| publisher | Japan Epidemiological Association |
| record_format | Article |
| series | Journal of Epidemiology |
| spelling | doaj.art-40e1c132e0464af3b63684318f2533f42023-04-05T08:28:46ZengJapan Epidemiological AssociationJournal of Epidemiology0917-50401349-90922023-03-0133314214910.2188/jea.JE20210242Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive PatientsPanpan He0Huan Li1Zhuxian Zhang2Yuanyuan Zhang3Tengfei Lin4Yun Song5Lishun Liu6Min Liang7Jing Nie8Binyan Wang9Yong Huo10Fan Fan Hou11Xiping Xu12Xianhui Qin13Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaBeijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, ChinaBeijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, ChinaBeijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaInstitute of Biomedicine, Anhui Medical University, Hefei, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaDivision of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, ChinaBackground: The association between changes in estimated glomerular filtration rate (eGFR) over time and the risk of stroke remains inconclusive. We aimed to evaluate the relation of eGFR change during the China Stroke Primary Prevention Trial (CSPPT) with the risk of first stroke during the subsequent post-trial follow-up. Methods: A total of 11,742 hypertensive participants with two eGFR measurements (median measure interval, 4.4; interquartile range, 4.2–4.6 years) and without a history of stroke from the CSPPT were included in this analysis. Results: Over a median post-trial follow-up of 4.4 years, 729 first strokes were identified, of which 635 were ischemic, 88 were hemorrhagic, and 6 were uncertain types of strokes. Compared with those with 1 to <2% per year increase in eGFR (with the lowest stroke risk), those with an increase in eGFR of ≥4% per year had significantly increased risks of first stroke (adjusted hazard ratio [HR] 1.96; 95% confidence interval [CI], 1.10–3.50) and first ischemic stroke (adjusted HR 2.14; 95% CI, 1.17–3.90). Similarly, those with a decline in eGFR of ≥5% per year also had significantly increased first stroke (adjusted HR 2.13; 95% CI, 1.37–3.31) and first ischemic stroke (adjusted HR 1.89; 95% CI, 1.19–3.02) risk. However, there was no significant association between eGFR change and first hemorrhagic stroke. A similar result was found when the change in eGFR was quantified as an absolute annual change. Conclusion: In Chinese hypertensive patients, both the decline and increase of eGFR levels were independently associated with the risks of first stroke or first ischemic stroke.https://www.jstage.jst.go.jp/article/jea/33/3/33_JE20210242/_pdfchange in egfrfirst strokefirst ischemic strokehypertension |
| spellingShingle | Panpan He Huan Li Zhuxian Zhang Yuanyuan Zhang Tengfei Lin Yun Song Lishun Liu Min Liang Jing Nie Binyan Wang Yong Huo Fan Fan Hou Xiping Xu Xianhui Qin Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients Journal of Epidemiology change in egfr first stroke first ischemic stroke hypertension |
| title | Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients |
| title_full | Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients |
| title_fullStr | Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients |
| title_full_unstemmed | Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients |
| title_short | Change in the Estimated Glomerular Filtration Rate Over Time and Risk of First Stroke in Hypertensive Patients |
| title_sort | change in the estimated glomerular filtration rate over time and risk of first stroke in hypertensive patients |
| topic | change in egfr first stroke first ischemic stroke hypertension |
| url | https://www.jstage.jst.go.jp/article/jea/33/3/33_JE20210242/_pdf |
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