Association of acute kidney disease with the prognosis of ischemic stroke in the Third China National Stroke Registry

BACKGROUND: Acute kidney disease (AKD) evolves a spectrum of acute and subacute kidney disease requiring a global strategy to address. The present study aimed to explore the impact of AKD on the prognosis of ischemic stroke. METHODS: The Third China National Stroke Registry (CNSR-III) was a nationwide registry of ischemic stroke or transient ischemic attack between August 2015 and March 2018. As a subgroup of CNSR-III, the patients who had serum creatinine (sCr) and serum cystatin C (sCysC) centrally tested on admission and at 3-month, and with 1-year follow-up data were enrolled. Modified AKD criteria were applied to identify patients with AKD during the first 3 months post stroke according to the guidelines developed by the Kidney Disease: Improving Global Outcomes in 2012. The primary clinical outcome was 1-year all-cause death, and secondary outcomes were stroke recurrence and post stroke disability. RESULTS: Five thousand sixty-five patients were recruited in the study. AKD was identified in 3.9%, 6.7%, 9.9% and 6.2% of the patients by using sCr, sCr-based estimated glomerular filtration rate (eGFR(sCr)), sCysC-based eGFR (eGFR(sCysC)), and combined sCr and sCysC-based eGFR (eGFR(sCr+sCysC)) criteria, respectively. AKD defined as sCr or eGFR(sCr) criteria significantly increased the risk of all-cause mortality (adjusted HR 2.67, 95% CI: 1.27–5.61; adjusted HR 2.19, 95% CI: 1.17–4.10) and post stroke disability (adjusted OR 1.60, 95% CI: 1.04–2.44; adjusted OR 1.51, 95% CI: 1.08–2.11). AKD diagnosed by eGFR(sCysC) or eGFR(sCr+sCysC) criteria had no significant impact on the risk of all-cause death and post stroke disability. AKD, defined by whichever criteria, was not associated with the risk of stroke recurrence in the adjusted model. CONCLUSIONS: AKD, diagnosed by sCr or eGFR(sCr) criteria, were independently associated with 1-year all-cause death and post stroke disability in Chinese ischemic stroke patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-022-02817-4.