Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease

Bruce Ovbiagele, Lee H. Schwamm, Eric E. Smith, Maria V. Grau-Sepulveda, Jeffrey L. Saver, Deepak L. Bhatt, Adrian F. Hernandez, Eric D. Peterson, Gregg C. Fonarow

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in-hospital prognoses among patients with CKD in the Get With The Guidelines-Stroke (GWTG-Stroke) program Methods and Results: We analyzed 679 827 patients hospitalized with ischemic stroke from 1564 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. Use of 7 predefined ischemic stroke performance measures, composite "defect-free" care compliance, and in-hospital mortality were examined based on glomerular filtration rate (GFR) categorized as a dichotomous (+CKD as < 60) or rank-ordered variable: normal (≥90), mild (≥60 to <90), moderate (≥30 to <60), severe (≥15 to <30), and kidney failure (<15 or dialysis). There were 236 662 (35%) ischemic stroke patients with CKD. Patients with severe renal dysfunction or failure were significantly less likely to receive guideline-based therapies. Compared with patients with normal kidney function (≥90), those with CKD (adjusted OR 0.91 [95% CI: 0.89 to 0.92]), moderate dysfunction (adjusted OR 0.94 [95% CI: 0.92 to 0.97]), severe dysfunction (adjusted OR 0.80 [95% CI: 0.77 to 0.84]), or failure (adjusted OR 0.72 [95% CI: 0.68 to 0.0.76]), were less likely to receive 100% defect-free care measure compliance. Inpatient mortality was higher for patients with CKD (adjusted odds ratio 1.44 [95% CI: 1.40 to 1.47]), and progressively rose with more severe renal dysfunction. Conclusions: Despite higher in-hospital mortality rates, ischemic stroke patients with CKD, especially those with greater severity of renal dysfunction, were less likely to receive important guideline-recommended therapies.

Original languageEnglish (US)
Article number000905
JournalJournal of the American Heart Association
Volume3
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Chronic kidney disease
  • Glomerular Filtration Rate
  • Guidelines
  • Ischemic stroke
  • Outcomes
  • Prognosis
  • Quality indicators
  • Renal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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