Chronic kidney disease: prior stroke tied to adverse clinical outcomes

  • Tollitt J & al.
  • BMC Nephrol
  • 27 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with chronic kidney disease (CKD), prior stroke was independently associated with several adverse clinical outcomes including death, reaching end-stage renal disease (ESRD) and suffering another non-fatal cardiovascular event.

Why this matters

  • Findings highlight the importance of primary and secondary preventive measures to improve outcomes in CKD patients with prior stroke.

Study design

  • Study of 3060 patients (aged ≥18 years) with all-cause non-dialysis CKD and prior stroke.
  • Outcome: risks for death, non-fatal cardiovascular events (NFCVE) and end-stage renal disease (ESRD)
  • Funding: None.

Key results

  • In all, 277 (9.1%) patients had a history of stroke.
  • At recruitment, patients with prior stroke vs those without had a significant increase in frequencies of:
    • incident stroke (8.8% vs 2.9%; P<.01>
    • myocardial infarction (10.6% vs 5.4%; P<.01>
    • all NFCVE (26.4% vs 11.3%; P<.01>
    • reaching ESRD (40.5% vs 31.3%; P<.01 and>
    • all-cause mortality (69.2% vs 45%; P<.01>
  • At recruitment, prior stroke was independently associated with:
    • mortality (HR, 1.20; 95% CI, 1.0-1.43; P=.05),
    • ESRD (HR, 1.34; 95% CI, 1.06-1.69; P=.02) and
    • future NFCVE (HR, 1.54; 95% CI, 1.12-2.11; P=.01).
  • Patients with prior stroke at dialysis commencement vs those without had a significantly higher all-cause mortality (65% vs 49%; HR, 1.46; 95% CI, 1.006-2.14; P=.047).

Limitations

  • Lack of data on stroke severity.
  • Study predominantly included Caucasian population.