MacWalter, RSWong, SYSWong, KYKStewart, GFraser, CGFraser, HWErsoy, Y2024-08-042024-08-0420020039-24991524-4628https://doi.org/10.1161/01.STR.0000016344.49819.F7https://hdl.handle.net/11616/93397Background and Purpose-The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke. Methods-This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between 1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality. Results-The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine < 124 mumol/L. The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance greater than or equal to51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine greater than or equal to119 mumol/L [relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92], urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or greater than or equal to9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine greater than or equal to0.08573 mmol/mumol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders. Conclusions-After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.eninfo:eu-repo/semantics/openAccesscerebrovascular disorderscreatininekidney function testsmortalityprognosisrenal disease, end-stagestrokeureaArticle336163016351205300310.1161/01.STR.0000016344.49819.F72-s2.0-0036278176Q1WOS:000176164300047Q1