Background and Purpose—: Low estimated glomerular filtration rate (eGFR) is known to be associated with clinical adverse outcomes. However, whether diabetes mellitus influences the association between eGFR and prognosis of stroke is still not elucidated. Methods—: Prospective cohort of 17 280 (nondiabetic 12 498 and diabetic 4782) Chinese patients with acute stroke from the China National Stroke Registry and from abnormal glucose regulation in patients with acute stroke across China (ACROSS) between 2007 and 2009 were followed-up for 1 year for all-cause mortality, stroke recurrence, and stroke disability related to baseline eGFR in the presence and absence of diabetes mellitus. Results—: Among nondiabetic patients, as compared with eGFR of 90 to 119 mL/min per 1.73 m ² , the adjusted odds ratio of lower eGFR of < 45 mL/min per 1.73 m ² was 2.79 (95% confidence interval, 2.09–3.73) for all-cause mortality, 2.28 (1.74–2.98) for stroke recurrence, and 1.53 (1.16–2.01) for stroke disability; higher eGFR of ≥120 mL/min per 1.73 m ² was just significantly associated with higher risk of all-cause mortality (odds ratio, 1.38; 95% confidence interval, 1.02–1.86) but not with other outcomes. In diabetic patients, the adjusted odds ratios of all-cause mortality, stroke recurrence, and stroke disability in lower eGFR were 2.16 (1.51–3.08), 1.43 (1.02–2.00), and 1.38 (0.98–1.95), respectively; higher eGFR was significantly associated with higher risks of all stroke outcomes. Conclusions—: Decreased eGFR (<45 mL/min per 1.73 m ² ) is a strong predictor of all-cause mortality, stroke recurrence, and stroke disability in diabetic and nondiabetic patients with acute stroke. Increased eGFR (≥120 mL/min per 1.73 m ² ) is associated with all of stroke outcomes in diabetic patients and linked to all-cause mortality in nondiabetic patients.

Background: Current evaluation about the relationship of sequential change in estimated glomerular filtration rate ( eGFR ) and clinical outcomes are still inconsistent. We aimed to investigate the association between the change in kidney function over time and the risk of all‐cause mortality and cardiovascular disease. Methods and Results: This prospective cohort including 37 691 participants aged ≥45 years used data from the Kailuan Health Registry. The relationship of the annual percentage and absolute change in eGFR and outcomes were analyzed with Cox proportional regression. The participants were stratified according to the quintiles distribution of the percentage annual change in eGFR (Q1–Q5). After adjusting for baseline covariates including initial eGFR , participants with annual eGFR decline were at significantly greater risk for all‐cause mortality (Q1: hazard ratio, 1.22 [95% confidence interval, 1.04–1.43]; Q2: 1.19 [1.01–1.40]) than noted for patients in Q3. Cardiovascular disease risk was also significantly higher in participants with annual eGFR decline (Q1 and Q2). No significantly increased risk of adverse outcomes was noted for patients with annual eGFR increased groups (Q4 and Q5). When considering the absolute eGFR annual change rate (no/mild/rapid decline), we obtained similar results in chronic kidney disease participants, whereas non–chronic kidney disease participants had less pronounced association of eGFR decline with cardiovascular disease, though not with mortality. Conclusions: A decline in eGFR over time is associated with higher risk for all‐cause mortality and cardiovascular disease independent of initial eGFR and other known risk factors at baseline. Our data support the serial evaluation of change in kidney function as a better prognostic indicator than single eGFR assessments.

Purpose: The study aimed to determine the prevalence and risk factors of frailty among a Chinese cohort of hemodialysis patients and to assess the degree to which frailty was associated with all-cause mortality. Participants and Methods: We enrolled a group of older adults (≥ 60 years old) in a prospective cohort study of cognitive impairment in Chinese patients undergoing hemodialysis (registered in Clinical Trials.gov, ID: NCT03251573). We assessed the prevalence of frailty using Fried’s definition in the Cardiovascular Health Study, then we evaluated the associated risk factors of frailty using multivariate logistic regression analysis. Finally, we assessed the association of frailty and all-cause mortality with multivariable Cox proportional hazard regression analyses. Results: The prevalence of frailty in these 204 enrolled hemodialysis patients was 72.1%. Patients with frailty were more inclined to have composite abnormal components that included poor physical functioning, exhaustion, low physical activity, and undernutrition. Multivariable logistic regression analysis suggested that increased age, female gender, history of diabetes, longer dialysis vintage, lower Kt/V, lower serum level of albumin concentrations, and increased serum iPTH concentrations were independently associated with frailty. Cox regression analysis indicated that frailty as a dichotomous construct was strongly associated with an increased risk of mortality (HR 6.092, 95% CI 1.886– 19.677, P = 0.003) in unadjusted analyses. After adjusting (Model I = no adjusted; II = adjusted for age, gender; III = adjusted for age, gender, history of diabetes; IV = adjusted for all covariates associated at the p ≤ 0.10 level with death in unadjusted analyses, including age, history of diabetes, MoCA< 26, single-pool Kt/V, and the levels of albumin and iPTH), the association was slightly affected but observed consistent as before. Conclusion: Frailty is extremely common and is associated with serious clinical outcomes among older hemodialysis patients. Based on those clinical features of frailty, future studies should focus on exploring effective interventions aimed to prevent or attenuate frailty in the older hemodialysis population.

The clinical epidemiological features of cognitive impairment in Chinese older adult patients undergoing hemodialysis are not clear, we aimed to identify the extent and patterns of cognitive impairment among those patients. We conducted a cross-sectional study of 613 hemodialysis patients aged 50 to 80 from 11 centers in Beijing. A neuropsychological battery of 11 tests covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied, patients were classified as none, mild, or major cognitive impairment according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria for cognitive impairment. Compared with Chinese population norms, 37.2% of the participants had mild cognitive impairment, 43.7% had major cognitive impairment. Memory and language were the most severe impaired domains in the mild cognitive impairment group, attention and visuospatial function domains were the most serious impaired domains in the major cognitive impairment group. Concomitant impairment across multiple cognitive domains was common. Factors associated with major cognitive impairment included age, education level, history of stroke and hypertension, dialysis vintage, and single-pool Kt/V. There is a high frequency of cognitive impairment in Chinese older adult hemodialysis patients, with varying severity and concomitant impairment across multiple domains.

Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard. We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman’s correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment. Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman’s rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (r_s = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859–0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786–0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752. The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.