Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Abstract

Chronic kidney disease is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in patients with chronic kidney disease, accounting for this association. However, factors unique to these patients, such as uremia, oxidative stress, and mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with chronic kidney disease, especially those who are dialysis dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventive and therapeutic interventions for stroke in the general population. In this review, we explore the complexities and challenges of these interventions in the population with renal disease.

Association between Estimated Glomerular Filtration Rate and Clinical Outcomes in Ischemic Stroke Patients with High-Grade Carotid Artery Stenosis

“…Our study revealed that older age, hypertension, DM, CAD and hyperuricemia occurred more frequently in patients with reduced eGFR≺45 mL/min/1.73 m 2 , which was in agreement to previous study [16,18]. Older age [21], hypertension [22], DM [23], and gout [24] were known risk factors of CKD.…”

“…Our study demonstrated that reduced eGFR, especially in the group with eGFR≺45 mL/min/1.73 m 2 , can predict 5-year all-cause mortality in acute IS patients with high-grade CAS. Previous studies had revealed that impaired eGFR is independently associated with increased risk of all-cause mortality in overall population [16,17] and IS patients [18]. Of the IS patients with high-grade CAS whose eGFR≺45 mL/min/1.73 m 2 that died, only about 6% died from the acute stroke, which may be explained by that the stroke severity was not signi cantly different between the groups with different eGFR.…”

Association between Estimated Glomerular Filtration Rate and Clinical Outcomes in Ischemic Stroke Patients with High-Grade Carotid Artery Stenosis

“…Our study revealed that older age, hypertension, DM, CAD and hyperuricemia occurred more frequently in patients with reduced eGFR≺45 mL/min/1.73 m 2 , which was in agreement to previous study [16,18]. Older age [21], hypertension [22], DM [23], and gout [24] were known risk factors of CKD.…”

“…Our study demonstrated that reduced eGFR, especially in the group with eGFR≺45 mL/min/1.73 m 2 , can predict 5-year all-cause mortality in acute IS patients with high-grade CAS. Previous studies had revealed that impaired eGFR is independently associated with increased risk of all-cause mortality in overall population [16,17] and IS patients [18]. Of the IS patients with high-grade CAS whose eGFR≺45 mL/min/1.73 m 2 that died, only about 6% died from the acute stroke, which may be explained by that the stroke severity was not signi cantly different between the groups with different eGFR.…”

The Relevance of Thrombo-Inflammatory Biomarkers and Their Relationship with Circulating Glycosaminoglycans in End-Stage Renal Disease Patients

“…65 Furthermore, although the established methods have certain success rates in the general population, they are less successful in ESRD patients and newer approaches are essential. [62][63][64] In this study, our results have shown that only CRP levels were significantly higher in ESRD patients diagnosed with CAD. There was not any significant difference found in the levels of other biomarkers in terms of CAD.…”

Effects of GLP ‐1 receptor agonists on incidence and outcomes of ischemic stroke and myocardial infarction: A systematic review and meta‐analysis

“…Similarly, for patients with coronary disease, these agents offer powerful protection against recurrent MI. The identification of stronger stroke protection in patients with renal dysfunction matches with rising evidence of greater cerebrovascular vulnerability in chronic kidney disease and suggests special benefit in this high‐risk population 30–32 …”

Association between Estimated Glomerular Filtration Rate and Clinical Outcomes in Ischemic Stroke Patients with High-Grade Carotid Artery Stenosis

“…Our study revealed that older age, hypertension, DM, CAD and hyperuricemia occurred more frequently in patients with reduced eGFR≺45 mL/min/1.73 m 2 , which was in agreement to previous study [16,18]. Older age [21], hypertension [22], DM [23], and gout [24] were known risk factors of CKD.…”

“…Our study demonstrated that reduced eGFR, especially in the group with eGFR≺45 mL/min/1.73 m 2 , can predict 5-year all-cause mortality in acute IS patients with high-grade CAS. Previous studies had revealed that impaired eGFR is independently associated with increased risk of all-cause mortality in overall population [16,17] and IS patients [18]. Of the IS patients with high-grade CAS whose eGFR≺45 mL/min/1.73 m 2 that died, only about 6% died from the acute stroke, which may be explained by that the stroke severity was not signi cantly different between the groups with different eGFR.…”

The Relevance of Thrombo-Inflammatory Biomarkers and Their Relationship with Circulating Glycosaminoglycans in End-Stage Renal Disease Patients

“…65 Furthermore, although the established methods have certain success rates in the general population, they are less successful in ESRD patients and newer approaches are essential. [62][63][64] In this study, our results have shown that only CRP levels were significantly higher in ESRD patients diagnosed with CAD. There was not any significant difference found in the levels of other biomarkers in terms of CAD.…”

Effects of GLP ‐1 receptor agonists on incidence and outcomes of ischemic stroke and myocardial infarction: A systematic review and meta‐analysis

“…Similarly, for patients with coronary disease, these agents offer powerful protection against recurrent MI. The identification of stronger stroke protection in patients with renal dysfunction matches with rising evidence of greater cerebrovascular vulnerability in chronic kidney disease and suggests special benefit in this high‐risk population 30–32 …”

Association between Estimated Glomerular Filtration Rate and Clinical Outcomes in Ischemic Stroke Patients with High-Grade Carotid Artery Stenosis

“…Our study revealed that older age, hypertension, DM, CAD and hyperuricemia occurred more frequently in patients with reduced eGFR≺45 mL/min/1.73 m 2 , which was in agreement to previous study [16,18]. Older age [21], hypertension [22], DM [23], and gout [24] were known risk factors of CKD.…”

“…Our study demonstrated that reduced eGFR, especially in the group with eGFR≺45 mL/min/1.73 m 2 , can predict 5-year all-cause mortality in acute IS patients with high-grade CAS. Previous studies had revealed that impaired eGFR is independently associated with increased risk of all-cause mortality in overall population [16,17] and IS patients [18]. Of the IS patients with high-grade CAS whose eGFR≺45 mL/min/1.73 m 2 that died, only about 6% died from the acute stroke, which may be explained by that the stroke severity was not signi cantly different between the groups with different eGFR.…”

The Relevance of Thrombo-Inflammatory Biomarkers and Their Relationship with Circulating Glycosaminoglycans in End-Stage Renal Disease Patients

“…65 Furthermore, although the established methods have certain success rates in the general population, they are less successful in ESRD patients and newer approaches are essential. [62][63][64] In this study, our results have shown that only CRP levels were significantly higher in ESRD patients diagnosed with CAD. There was not any significant difference found in the levels of other biomarkers in terms of CAD.…”

Effects of GLP ‐1 receptor agonists on incidence and outcomes of ischemic stroke and myocardial infarction: A systematic review and meta‐analysis

“…Similarly, for patients with coronary disease, these agents offer powerful protection against recurrent MI. The identification of stronger stroke protection in patients with renal dysfunction matches with rising evidence of greater cerebrovascular vulnerability in chronic kidney disease and suggests special benefit in this high‐risk population 30–32 …”