eGFR and stroke risk

January 01, 0001

eGFR and stroke risk

These Taiwanese and US researchers investigated the association between estimated glomerular filtration rate (eGFR) and risk of future stroke. They performed a systematic review and meta-analysis of prospective studies using PubMed and Embase. Two investigators independently abstracted the data , and estimates were combined using a random effects model. Heterogeneity was assessed by P value of ÷2 statistics and I2. Publication bias was assessed via funnel plots.

The researchers found: "21 articles derived from 33 prospective studies: 14 articles assessed eGFR <60 ml/min/1.73 m2 and seven assessed eGRF at both <60 ml/min/1.73 m2 and 60-90 ml/min/1.73 m2 for a total of 284?672 participants (follow-up 3.2-15 years) with 7863 stroke events. Incident stroke risk increased among participants with an eGFR <60 ml/min/1.73 m2 (relative risk 1.43) but not among those with an eGFR of 60-90 ml/min/1.73 m2 (1.07). Significant heterogeneity existed between estimates among patients with an eGFR <60 ml/min/1.73 m2. In subgroup analyses among participants with an eGFR <60 ml/min/1.73 m2, heterogeneity was significant in Asians compared with non- Asians (1.96 v 1.25), and those with an eGFR of 40-60 ml/min/1.73 m2 v <40 ml/min/1.73 m2 (1.28 v 1.77)."

The researchers concluded: "A baseline eGFR <60 ml/min/1.73 m2 was independently related to incident stroke across a variety of participants and study designs. Prompt and appropriate implementation of established strategies for reduction of vascular risk in people with know renal insufficiency may prevent future strokes."

This systematic review found an increased risk of stroke in patients with an eGFR <60 ml/min/1.73 m2, suggesting a role for intervention to lower risk.

For the full abstract, click here.

BMJ 341:c4249, 30 September 2010
© 2010 Lee et al.
Low glomerular filtration rate and risk of stroke: meta-analysis. Meng Lee, Jeffrey L Saver, Kuo-Hsuan Chang, Hung-Wei Liao, Shen-Chih Chang, Bruce Ovbiagele. Correspondence to B Ovbiagele:

Category: K. Circulatory, U. Urinary System. Keywords: chronic kidney disease, eGFR, glomerular filtration rate, stroke, cerebrovascular disease, systematic review and meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 22 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.