Low GFR; a high risk for recurrent strokes

This study examined the association of low glomerular filtration rate (GFR) with stroke risk and evaluated whether renin-angiotensin system modulator therapy reduces the risk of strokes among patients with low GFR.

Glomerular filtration rate (GFR) is used as an indicator of kidney function, estimating how much blood is filtered through the kidney at any given minute. Low filtration rates usually indicates chronic kidney damage, possibly as a result of high blood pressure, heart disease or diabetes. Kidney disease is also a common cause for the initial development of high blood pressure. Both hypertension and kidney disease are known to be associated with the development of strokes, however the relationship between low GFR and recurrent stroke risk has not yet been thoroughly investigated.

Renin-angiotensin system modulators (RAS inhibitors), such as Telmisartan, are often used in the treatment of hypertension, in order to limit the progression of chronic kidney disease, and to reduce the risk of vascular events (such as strokes) among patients with heart disease. However, the potential stroke-risk benefits of RAS inhibitors among patients with chronic kidney damage are still unclear.

A total of 18,666 patients at high stroke risk (those with a recent ischemic stroke event) were analyzed in this study. Low GFR was noted in 3,630 patients. Results were analyzed following an average follow up of 2.5 years.
After accounting for multiple variables, results showed a 20% increase in the risk of additional strokes among patients with significant kidney damage (defined as GFR<60 mL/min). However, among patients with low GFR, RAS inhibitor treatment did not seem to reduce the risk of recurrent strokes.

This study concluded that while an elevated stroke risk exists among high risk patients with reduced GFR, RAS inhibitor therapy does not seem to reduce this risk.