A pooled analysis of patient data from the MICON international collaboration revealed that among patients with ischemic stroke (IS) or transient ischemic attack, impaired kidney function was associated with a higher risk of current stroke and higher microbleeds burden, relative to those with normal kidney function. Study authors concluded that impaired kidney function may identified high-risk patients for recurrent stroke, as well as optimizing treatment decisions to prevent recurrent vascular events.1
The analysis included 11,175 patients (mean age, 70.7 [±12.6]) with IS, of which 2815 (25.2%) had impaired kidney function, defined as estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. Through reocmmendations from the European Renal Association and the European Federation of Clinical Chemistry and Laboratory Medicine, the study authors chose to use the original 2009 CKD-EPI equation for estimate GFR, omitting the ethnicity coefficient.
Led by Jeremy Molad, MD, deputy director of the Neurology Division at Tel Aviv Medical Center, those with eGFR of less than 60 were older (mean age 77.3 [±9.8] vs 68.4 [±12.8]), had higher proportion of females (51.6% vs 39.1%) and had higher rates of all comorbidities. Over a median follow-up of 1 year, there were 802 primary outcome events, with higher rates of the composite outcome in the eGFR P
Between the two groups, the adjusted hazard ratio (aHR) for such events was 1.33 (95% CI, 1.14-1.54; P
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In the study, reduced renal function (eGFR
“Our study confirms that decreased eGFR provides predictive value for overt IS recurrence in patients with renal impairment receiving antithrombotic agents for secondary stroke prevention and that microbleeds do not alter the net harm of antithrombotic therapy,” Molad et al commented.
The lack of link between aticoagulant use, microbleed presence and the risk of recurrent IS or intracerebral hemorrhage has implications for clinical practice, “as many clinicians have expressed safety concerns regarding anticoagulant treatment in this high-risk population, supported by the superior safety and efficacy profile of Direct oral anti-coagulants (DOACs) compared with vitamin-K antagonists among CKD patients,” the study authors noted. “Nevertheless, we must interpret these findings with caution, given the observational nature of the current study, potential indication bias and the potential for incomplete adjustment for confounding variables.”
Beyond stroke recurrence, eGFR
REFERENCE
1. Molad J, Miwa K, Nash PS, et al. Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration. Neurol, Neurosurg, & Psych. 2025;96:842-851. doi:10.1136/jnnp-2024-335110