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 Link to paper on BMJ JournalsAuthorsMolad J, Miwa K, Nash PS, Ambler G, Best J, Wilson D, Hallevi H, Fandler-Höfler S, Eppinger S, Du H, Al-Shahi Salman R, Jäger HR, Lip GYH, Goeldlin MB, Beyeler M, Bücke P, El-Koussy M, Mattle HP, Panos LD, van Dam-Nolen DHK, Dubost F, Hendrikse J, Kooi ME, Mess W, Nederkoorn PJ, Shiozawa M, Christ N, Bellut M, Gunkel S, Karayiannis C, Van Ly J, Singhal S, Slater LA, Kim YD, Song TJ, Lee KJ, Lim JS, Hara H, Nishihara M, Tanaka J, Yoshikawa M, Demirelli DS, Tanriverdi Z, Uysal E, Coutts SB, Chappell FM, Makin S, Mak HK, Teo KC, Wong DYK, Hert L, Kubacka M, Lyrer P, Polymeris AA, Wagner B, Zietz A, Abrigo JM, Cheng C, Chu WCW, Leung TWH, Tsang SF, Yiu B, Seiffge DJ, Fischer U, Jung S, Enzinger C, Gattringer T, Bos D, Toyoda K, Fluri F, Phan TG, Srikanth V, Heo JH, Bae HJ, Yakushiji Y, Orken DN, Smith EE, Wardlaw JM, Lau KK, Engelter ST, Peters N, Soo Y, Wheeler DC, Simister RJ, Bornstein NM, Werring DJ, Ben Assayag E, Koga MAbstractBackground: Patients 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.Methods: We 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.Results: 11 175 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)).Conclusions: In 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.Keywords: STROKE. This article was published on 2025-04-30
