The Impact of Early Rehabilitation on Patients With Acute Cerebral Infarction and Chronic Kidney Disease: A Retrospective Cohort Study

TL;DR

This study shows that early rehabilitation benefits patients with both cerebral infarction and chronic kidney disease, regardless of kidney function severity.

Contribution

The study demonstrates that early rehabilitation improves outcomes in cerebral infarction patients with chronic kidney disease, regardless of CKD severity.

Findings

Early rehabilitation improved physical function and activities of daily living at discharge in patients with cerebral infarction and chronic kidney disease.

There was no significant difference in outcomes between patients with mild and severe chronic kidney disease after early rehabilitation.

Hospital stay duration was not affected by the severity of chronic kidney disease in patients undergoing early rehabilitation.

Abstract

Background and objective

Patients with cerebral infarction (CI) who also have chronic kidney disease (CKD) are at an increased risk of adverse outcomes. However, it remains uncertain whether the presence or severity of CKD influences the effectiveness of early rehabilitation. This study aimed to investigate the impact of early rehabilitation, taking into account both the presence and severity of CKD.

Methods

This study initially included 764 patients diagnosed with CI between April 2014 and March 2021 at Nerimahikarigaoka Hospital. From this cohort, 402 patients experiencing their first CI who underwent inpatient rehabilitation were selected as the study population. Patients were categorized into two groups according to estimated glomerular filtration rate (eGFR) using the modified formula from the 2018 Evidence-based Clinical Practice Guidelines for Chronic Kidney Disease, which applies to Japanese patients: the mild group (≥45 mL/min/1.73m2) and the severe group (<45 mL/min/1.73m2). Statistical analysis involved 1:1 propensity score matching based on background factors, and standardized mean differences (SMD) were calculated. After matching, 48 patients remained in each group, due to an imbalance in baseline renal function distribution. Variables were selected based on the definition of early mobilization and factors influencing renal function decline, including age, sex, stroke type, number of stroke risk factors, and days from hospital admission to initiation of wheelchair use, standing, and gait training. Both groups were compared in terms of the primary outcomes, namely the modified Rankin Scale (mRS) and Barthel Index (BI) scores at discharge, as well as hospital stay duration.

Results

The SMDs for background factors after propensity score matching were as follows: age (0.013), time to initiation of wheelchair use (0.16), time to start of standing rehabilitation (0.071), mRS at admission (0.068), and BI at admission (<0.001). No significant differences were observed between the two groups in mRS at discharge (p = 0.485), BI at discharge (p = 0.431), or length of hospital stay (p = 0.226).

Conclusions

Our study revealed that early rehabilitation in CI patients consistently improves physical function, activities of daily living at discharge, and length of hospital stay, irrespective of the presence or severity of CKD. These findings highlight the clinical significance of early mobilization in CI patients with CKD.

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