林口長庚-嘉義長庚的study，GFR小於60即有1.43倍CVA危險

GFR < 40cc/min/m2危險性更高，77%, independent to other risk factors

Low Glomerular Filtration Rate and Stroke Risk

A meta-analysis finds that low GFR can be considered a marker for increased stroke risk.

Low glomerular filtration rate (GFR; <60 mL/minute/1.73 m2) is associated with cardiovascular disease and cardiovascular mortality, but the association with stroke is less clear. To investigate this link qualitatively and quantitatively, these authors conducted a meta-analysis of 21 articles derived from 33 prospective studies that included more than 280,000 people and almost 8000 strokes.

In a random-effects model of pooled results, the relative risk for incident stroke with a low estimated GFR (eGFR) was 1.43. Asians and those with an eGFR below 40 mL/minute/1.73 m2 had higher risks than others. The effect of low eGFR on the risk for fatal strokes was more profound than for fatal plus nonfatal strokes. Among the 11 studies that reported adjustments for cardiovascular risk factors, the risk was attenuated but remained significant after adjustments. The authors conclude that low eGFR may reasonably be considered a marker for increased stroke risk.

Comment: This excellent meta-analysis shows that low GFR should be considered a risk factor for stroke, particularly fatal stroke. As the authors note, compromise of the kidney increases risk factors for generally poor clinical outcomes such as inflammation, electrolyte derangements, procoagulation, and the presence of uremic toxins. In fact, kidney disease of even mild severity is an independent predictor of poorer clinical outcome among patients with stroke. In Asian populations, hypertension is a major risk factor for both stroke and death from renal causes; a low GFR increases stroke risk even more. The current findings suggest that patients with low GFRs should be considered for well-known risk-reduction strategies such as control of blood pressure and hyperlipidemia and antiplatelet therapy. Patients (such as Asians) with a high risk for hypertension may particularly benefit from a close assessment of renal function and GFR.

— Jaime Toro, MD

Published in Journal Watch Neurology October 26, 2010
Citation(s):

Lee M et al. Low glomerular filtration rate and risk of stroke: Meta-analysis. BMJ 2010 Sep 30; 341:c4249.

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