Journal Article

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

Lim, Jae-Sung, Simister, Robert J, Bae, Hee-Joon, Teo, Kay Cheong, Yiu, Brian, Engelter, Stefan T, Eppinger, Sebastian, Ben Assayag, Einor, Gattringer, Thomas, Tanaka, Jun, Mak, Henry Ka-Fung, Jäger, Hans R, Bücke, Philipp, Karayiannis, Christopher, Tsang, Suk Fung, Nederkoorn, Paul J, Van Ly, John, Chappell, Francesca M, Enzinger, Christian, Hara, Hideo, Wagner, Benjamin, Nishihara, Masashi, Cheng, Cyrus, Ambler, Gareth, Werring, David J, Fandler-Höfler, Simon, Christ, Nicolas, Hendrikse, Jeroen, Beyeler, Morin, Lee, Keon-Joo, Srikanth, Velandai, Tanriverdi, Zeynep, Makin, Stephen, Bornstein, Natan M, Leung, Thomas W H, Shiozawa, Masayuki, Demirelli, Derya Selcuk, Yakushiji, Yusuke, Goeldlin, Martina B, Singhal, Shaloo, Wong, Debbie Y K, Panos, Leonidas D, Seiffge, David J, Orken, Dilek Necioglu, Hert, Lisa, Bos, Daniel, Fischer, Urs, Fluri, Felix, Yoshikawa, Masaaki, Slater, Lee-Anne, Heo, Ji Hoe, Smith, Eric E, Kim, Young Dae, Wheeler, David C, Kubacka, Marta, Best, Jonathan, Zietz, Annaelle, Coutts, Shelagh B, Lip, Gregory Y H, Phan, Thanh G, van Dam-Nolen, Dianne H K, Du, Houwei, Kooi, M Eline, Koga, Mas

2025

Overview

BackgroundPatients 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.MethodsWe 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 m2. 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.Results11 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)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) −2.10 mL/min/1.73 cm2 (95% CI −3.39 to −0.81)) and mixed microbleeds (aMD −2.42 (95% CI −3.70 to −1.15)), but not strictly deep microbleeds (aMD −0.67 (95% CI −1.85 to 0.51)).ConclusionsIn patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Aged / Aged, 80 and over / Anticoagulants / Cardiovascular disease / Cerebral Hemorrhage - epidemiology / Cerebrovascular Disease / Collaboration / Diabetes / Female / Females / Glomerular Filtration Rate / Hemorrhage / Humans / Hypertension / Intracranial Hemorrhages - epidemiology / Ischemia / Ischemic Stroke - epidemiology / Kidney diseases / Male / Meta-analysis / Middle Aged / Missing data / Original Research / Patients / Recurrence / Regression analysis / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - epidemiology / Renal Insufficiency, Chronic - physiopathology / Risk Factors / Sensitivity analysis / STROKE / Stroke - epidemiology / Transient ischemic attack