Neurology

Author response: The dimension of preventable stroke in a large representative patient cohort




We thank Dr. Kelly for the thoughtful comment on our article,1 which allows us to highlight important aspects regarding chronic kidney disease (CKD) in our work. In fact, CKD is an underrecognized important risk factor for ischemic stroke, potentially affecting safety and efficacy of cardiovascular prevention therapy. In our large cohort of patients with ischemic stroke or TIA, no less than 27.6% (95% CI, 25.5%–29.7%) had a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 upon hospital admission. The frequency of GFR categories G4 (GFR 15–29) and G5 (GFR < 15) were rather low at 1.4% (0.9%–2.0%) and 0.3% (0.2%–0.4%). These proportions must be interpreted such that the most severe strokes with permanent severe disability (mRS = 5 at hospital discharge) were excluded and proportions of severely decreased GFR and kidney failure are presumably higher in this latter group. Patients with a GFR less vs greater or equal 60 mL/min/1.73 m2 showed similar proportions of at least one untreated or inadequately treated cardiovascular risk factor (80.7% vs 79.0%).

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