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Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease.
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.
Type
Journal articleSubject
chronic kidney diseaseglomerular Filtration Rate
guidelines
ischemic stroke
outcomes
prognosis
quality indicators
renal
Adolescent
Adult
Aged
Aged, 80 and over
Female
Glomerular Filtration Rate
Guideline Adherence
Hospital Mortality
Hospitals
Humans
Male
Middle Aged
Prognosis
Quality of Health Care
Renal Insufficiency, Chronic
Stroke
United States
Young Adult
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https://hdl.handle.net/10161/15010Published Version (Please cite this version)
10.1161/JAHA.114.000905Publication Info
Ovbiagele, Bruce; Schwamm, Lee H; Smith, Eric E; Grau-Sepulveda, Maria V; Saver, Jeffrey
L; Bhatt, Deepak L; ... Fonarow, Gregg C (2014). Patterns of care quality and prognosis among hospitalized ischemic stroke patients
with chronic kidney disease. J Am Heart Assoc, 3(3). pp. e000905. 10.1161/JAHA.114.000905. Retrieved from https://hdl.handle.net/10161/15010.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Adrian Felipe Hernandez
Duke Health Cardiology Professor
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
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