Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
External Validation of the Nelson Equation for Kidney Function Decline in Patients with Acute Ischemic Stroke or Transient Ischemic Attack
First author：Hongyu Zhou
Corresponding author：Yongjun Wang,Yuesong Pan
essential_information
- Person in charge：Hongyu Zhou
- Data Sources： CNSR-Ⅲ
- Number of papers：CNSR-Ⅲ20200176
- Published time：2023-06-06
2023-06-06
Published articles
Journal：Clinical Interventions in Aging
Publication type: Original Contributions
IF(IF): 3.829
PMID: 37304172 Link To Pubmed Full text Download
Background And Purpose
Previous studies suggest a cross-talk between the brain and kidney after stroke.1 However, most research discussed the adverse effects of kidney disease on the of stroke prognosis. The effect of brain injury on kidney function remains unexplored. Recently, a new risk prediction equation for incident chronic kidney disease has been proposed.2 We aimed to validate this equation in patients with acute ischemic stroke or transient ischemic attack.
Method
A total of 3169 patients were enrolled in the Third China National Stroke Registry, whose baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. The outcome of interest was the incident eGFR< 60 mL/min/1.73 m2 at 3 months. The prediction equation of participants with or without diabetes was validated respectively. The receiver operating characteristic curve (AUC) evaluated prediction performance. The Delong test compared the Nelson equation performance with the O’Seaghdha equation and the Chien equation. Continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were determined to evaluate the incremental effect.
Conclusion
The Nelson equation reliably predicted the risks of the new-onset and long-term kidney function decline in patients with AIS or TIA, which could help clinicians screen high-risk patients and improve clinical care.
Main results
During the 3-mo follow-up period, among 1151 patients with diabetes, there were 31 cases (2.7%) of reduced eGFR. Meanwhile, among 2018 non-diabetic patients, there were 23 cases (1.1%) of reduced eGFR. The Nelson equation showed good discrimination and was well-calibrated in patients with diabetes (AUC 0.82, Hosmer-Lemeshow test p = 0.67) or without diabetes (AUC 0.82, Hosmer-Lemeshow test p = 0.09). The performance of the Nelson equation was superior to other equation, as increased continuous NRI (diabetic, 0.64; non-diabetic, 1.13) and IDI (diabetic, 0.10; non-diabetic, 0.13) to the Chien equation.