Journal of Stroke and Cerebrovascular Diseases · Nov 27, 2020

Elevated Creatinine-Based Estimated Glomerular Filtration Rate is Associated with Increased Risk of Sarcopenia, Dysphagia, and Reduced Functional Recovery after Stroke

By Yoshimura Y, Wakabayashi H, Nagano F et al.

OBJECTIVES: To evaluate the associations between estimated glomerular filtration rate (eGFR) and sarcopenia and functional outcomes after stroke. METHODS: This retrospective cohort study included hospitalized patients after stroke. Data on serum creatinine-based eGFR were extracted from medical records. Primary outcome was the presence of sarcopenia at admission, diagnosed based on both low skeletal muscle mass and strength criteria as per the AWGS 2019. Other outcomes included the Food Intake Level Scale (FILS) score (measure of dysphagia, FILS score <7) at discharge and the Functional Independence Measure-motor (FIM-motor) score at discharge and its change from the baseline. Multivariate analyses were performed to determine the association between eGFR and outcomes. RESULTS: Data from 813 patients (mean age 73.5 years; 51.9% men) were included in the analysis. The median eGFR was 65.1 ml/min/1.73 m², and about 41% of patients had an eGFR less than 60 ml/min/1.73 m² at the baseline. Sarcopenia was observed in 47.4% of patients. In the multivariate analyses, baseline eGFR was positively associated with sarcopenia at admission (odds ratio [OR]=1.016, 95% confidence interval [CI]: 1.005-1.027, p = 0.003), the presence of dysphagia at discharge (OR=1.016, 95% CI: 1.001-1.031, p = 0.045), and negatively associated with FIM-motor score at discharge (β= -0.046, p = 0.047) and its gain (β= -0.067, p = 0.037). CONCLUSIONS: Elevated creatinine-based eGFR is associated with sarcopenia, dysphagia, and adverse rehabilitation outcomes after stroke. Our findings highlight the limitations of assessing renal function using creatinine levels in patients with sarcopenia: therefore, future studies using cystatin C are needed to validate our findings.

doi.org/10.1016/j.jstrokecerebrovasdis.2020.105491 PubMed 33253988 Biomarkers