Association between kidney measurements and cognitive performance in patients with ischemic stroke

Abstract Background Relationships between low estimated glomerular filtration rate (eGFR) and albuminuria with poorer cognitive performance in patients with ischemic stroke are less clear. Our aim was to retrospectively ascertain the associations between these renal measures and cognitive performance in patients with ischemic stroke. Methods Retrospective analysis was performed on 608 patients with acute ischemic stroke. Urine albumin-creatinine ratio (UACR) and eGFR were obtained from inpatient medical records. Global cognitive function via mini-mental state exam (MMSE) and Montreal Cognitive Assessment (MoCA) was determined one month after hospital discharge. The relationship between renal measures and cognitive performance was assessed using univariate and multiple linear regression analyses. Results Patients had an average age of 66.6±4.1 years, and 48% were females. Average eGFR and UACR were 88.4±12.9 ml/min/1.73m 2 and 83.6±314.2 mg/g, respectively. The number of patients with an eGFR of ≥90, 60 to 89, and <60 ml/min/1.73 m 2 were (371, 61%), (207, 34%) and (30, 5%) respectively. The proportions with a UACR <30 mg/g, 30-300mg/g and >300 mg/g were 56%, 39% and 5%. Multivariate adjusted models showed that eGFR was independently associated with MMSE (β= –0.4; 95% CI= –0.5,-0.4; p <0.001) and MoCA (β = –0.6; 95% CI= –0.7,-0.5; p <0.001). However, the correlations between UACR and MMSE and MoCA were statistically non-significant. Conclusion In patients with ischemic stroke, reduced eGFR but not albuminuria was associated with lower cognitive performance. These results show that the eGFR decline could be an effective indicator of cognitive impairment after a stroke. Therefore, regular monitoring and early detection of mild renal dysfunction in patients with acute ischemic stroke might be needed.