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Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study
Jerome L Abramson1, Claudine T Jurkovitz, Viola Vaccarino
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30306, USA. jabram3@emory.edu
Insights
Chronic kidney disease (CKD) and anemia significantly increase stroke risk in middle-aged adults. The combination of CKD with anemia poses a substantially higher risk than either condition alone.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Epidemiology
Background:
- Chronic kidney disease (CKD) is a known risk factor for stroke.
- Anemia is a common complication of CKD and may independently increase cardiovascular event risk.
- The synergistic effect of CKD and anemia on stroke risk requires further investigation.
Purpose of the Study:
- To investigate the combined impact of CKD and anemia on the risk of incident stroke.
- To determine if CKD and anemia interact to influence stroke risk in a community-based cohort.
Main Methods:
- Analysis of data from 13,716 participants in the Atherosclerosis Risk in Communities (ARIC) Study.
- Prospective follow-up for 9 years to assess incident stroke.
- CKD defined as creatinine clearance <60 mL/min; anemia defined by hemoglobin levels (<13 g/dL for men, <12 g/dL for women).
Main Results:
- CKD alone was associated with an increased stroke risk (HR 1.81).
- The presence of anemia substantially amplified the stroke risk associated with CKD (HR 5.43).
- The interaction between CKD and anemia on stroke risk was statistically significant (P < 0.01).
Conclusions:
- The combination of CKD and anemia significantly elevates stroke risk in middle-aged adults.
- This increased risk appears independent of other established stroke risk factors.
- Findings highlight the importance of screening for and managing anemia in CKD patients to mitigate stroke risk.
Background:
Chronic kidney disease (CKD) has been linked to higher stroke risk. Anemia is a common consequence of CKD, and recent evidence suggests anemia may increase risk of cardiovascular events. The combined effect of CKD and anemia on stroke risk, however, has not been investigated thoroughly. We analyzed data from a middle-aged, community-based cohort to determine if CKD and anemia interacted to affect stroke risk.
Methods:
Data on 13,716 participants in the prospective Atherosclerosis Risk in Communities (ARIC) Study were analyzed to assess the joint effect of CKD and anemia on risk of incident stroke during a 9-year follow-up period. CKD was defined as a creatinine clearance of <60 mL/min. Anemia was defined as hemoglobin levels of <13 g/dL for men or <12 g/dL for women.
Results:
Overall, CKD was associated with an increase in stroke risk after adjustment for other factors [hazard ratio HR) 1.81; 95% CI 1.26 to 2.02]. However, this association was modified substantially by anemia. In the presence of anemia, CKD was associated with a substantially higher risk of stroke compared to no CKD (HR 5.43; 95% CI 2.04 to 14.41). In contrast, when anemia was not present, CKD was associated with only a modest, nonsignificant elevation in stroke risk (HR 1.41; 95% CI 0.93 to 2.14). The interaction between CKD and anemia on risk of stroke was statistically significant (P < 0.01).
Conclusion:
Among middle-aged, community-based persons, the combination of CKD and anemia was associated with a substantial increase in stroke risk, independent of other known risk factors for stroke.