Chronic Kidney Disease and Drinking Status in Relation to Risks of Stroke and Its Subtypes

Abstract

Background and Purpose-Several epidemiological studies have established an association between chronic kidney disease (CKD), based on estimated glomerular filtration rate (GFR), and risk of stroke. However, sex-specific evidence for the relationship between CKD and risk of stroke and its subtypes is still limited. Methods-We conducted a prospective cohort study of 12 222 Japanese men and women age 40 to 69 years living in 4 communities under systematic surveillance of stroke incidence to determine the relationship between CKD and risk of stroke and its subtypes. Results-During the 17-year follow-up, there were 566 strokes (327 ischemic and 186 hemorrhagic strokes). GFR was inversely associated with age-and community-adjusted risk of total stroke for both men and women. Compared with the reference group without CKD (GFR Ն60 mL/min per 1.73m 2 ), the adjusted risks of total stroke for subjects with CKD (GFR Ͻ60 mL/min per 1.73m2 ) were 1.63 (1.22-2.17) for men and 1.51 (1.13-2.02) for women. Excess risk of stroke associated with CKD was identified primarily for hemorrhagic stroke among men and for ischemic stroke among women. After adjustment for traditional cardiovascular risk factors, associations remained statistically significant. When stratified by drinking status, excess risk of hemorrhagic stroke with CKD was confined to drinkers; adjusted risks were 4.18 (2.31-7.57) for men and 7.00 (1.92-25.56) for women. Conclusions-CKD was associated with increased risk of hemorrhagic stroke for men, and of ischemic stroke for women.This sex difference may partly be explained by the difference in prevalence of drinkers between men and women. (Stroke. 2011;42:2531-2537.)

Free thyroxine (FT4) and anemia in relation to drinking status of Japanese men: The Nagasaki islands study

“…We found that drinkers showed higher hemoglobin values than non-drinkers, which was compatible with the finding of previous studies [8,9]. Since the prevalence of drinkers among Japanese men is high [10], the risk of anemia may be confounded by drinking status. Moreover, the highest tertiles of FT4 for drinkers in our study showed a higher risk of anemia.…”

“…Furthermore, previous studies reported that light to moderate alcohol consumption might affect thyroid function [7] and that hemoglobin levels of drinkers were higher than those of non-drinkers [8,9]. Since the prevalence of drinkers is high among Japanese men [10], a study to investigate the association between thyroid function and anemia among Japanese men should take drinking status into account. To investigate those associations we conducted a cross-sectional study of Japanese men aged 30-89 years.…”

Impact of Decreased Estimated Glomerular Filtration Rate on Japanese Acute Stroke and Its Subtype

“…Previous reports have suggested that CKD might be a strong predictor of cerebral hemorrage including SAH (21,22). In the present study, the prevalence of SAH in the group with CKD may have been relatively low because the prevalence of cardiogenic cerebral embolism was higher in the group with than without CKD.…”

CKD is associated with recurrent ischemia but not with hemorrhagic transformation in acute ischemic stroke patients

“…8 A recent study showed sex difference as a risk factor in CKD that was associated with hemorrhagic stroke in men but ischemic stroke in women. 9 Meanwhile, ischemic stroke was also significantly associated with CKD in some other studies. 10,11 In a previous study, CKD was associated with recurrent cardiovascular disease in unstable coronary syndrome patients.…”