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Objective:  Chronic kidney disease is a worldwide public health problem that is recognized as an established risk factor for stroke. It remains unclear whether its distribution and clinical impact are consistent across ischemic stroke subtypes in patients with renal impairment. We determined if renal impairment was associated with the proportion of each stroke subtype to overall ischemic stroke patients and also associated with functional outcomes after each stroke subtype.    Methods:  Study subjects were 10,392 adult patients with an acute stroke from the register of the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database, between October 2016 and December 2019, whose baseline serum creatinine levels and/or a dipstick proteinuria were available. All ischemic strokes were classified according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. Unfavorable functional outcomes were dened as modied Rankin Scale (mRS) 3-6 at discharge. Mixed effect logistic regression was used to determine the relationship between the outcomes and the estimated glomerular filtration rate (eGFR), eGFR strata (&lt;45, 45-59, ≥60 mL/min/1.73 m 2 ), or dipstick proteinuria ≥1 adjusted for covariates.    Results:  Overall, 2,419 (23%) patients had eGFR 45-59 mL/min/1.73 m 2 , and 1,976 (19%) had eGFR &lt;45 mL/min/1.73 m 2 , including 185 patients (1.8%) receiving hemodialysis. Both the eGFR 45-59 and eGFR &lt;45 mL/min/1.73 m 2  were associated with a higher proportion of cardioembolic stroke (odds ratio [OR], 1.21 [95% confidence intervals (CI), 1.05–1.39] and 1.55 [1.34–1.79], respectively) and a lower proportion of small vessel occlusion (0.79 [0.69–0.90] and 0.68 [0.59–0.79], respectively). The similar association with the proportion of these two subtypes was proven in the analyses using decreased eGFR as continuous values. Both the eGFR&lt;45 mL/min/1.73 m 2  and proteinuria were associated with unfavorable functional outcomes in patients with cardioembolic stroke (OR, 1.30 [95% CI, 1.01–1.69] and 3.18 [2.03–4.98], respectively) and small vessel occlusion (OR, 1.44 [1.01–2.07] and 2.08 [1.08–3.98], respectively).    Conclusions:  Renal impairment contributes to the different distributions and clinical impacts across specific stroke subtypes, particularly evident in cardioembolic stroke and small vessel occlusion. This possibly indicates shared mechanisms of susceptibility and potentially enhancing pathways.

Etiology and Outcome of Ischemic Stroke in Patients With Renal Impairment Including Chronic Kidney Disease