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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impact of chronic kidney disease severity on causes of death after first-ever stroke: A population-based study using
Hsin-Hsu Wu1,2, Ting-Yu Chang2,3, Chi-Hung Liu2,3
1Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Patients with advanced chronic kidney disease (CKD) face higher mortality after stroke. Causes of death differ significantly by CKD stage, necessitating tailored treatment strategies for stroke patients with CKD.
Area of Science:
- Nephrology
- Neurology
- Public Health
Background:
- Stroke is a common and fatal complication in patients with chronic kidney disease (CKD).
- Understanding the specific causes of death post-stroke across different stages of CKD is crucial but not well-established.
Purpose of the Study:
- To investigate the impact of chronic kidney disease (CKD) severity on the causes of death following a first-ever stroke.
- To compare mortality rates and causes of death between various CKD stages in both ischemic and hemorrhagic stroke patients.
Main Methods:
- A retrospective multicenter cohort study analyzed stroke patients with CKD from 2007-2012.
- Data on causes and dates of death were obtained from Taiwan's National Death Registry Database.
- Outcomes, mortality rates, and causes of death were stratified by five CKD stages (G1-G5) for ischemic stroke (IS) and hemorrhagic stroke (HS) separately.
Main Results:
- Patients with advanced CKD (G5) exhibited the highest one-year mortality rates post-stroke (HR 5.28 for IS, 3.03 for HS vs. G1).
- In early CKD stages (G1-3), leading causes of death after IS were stroke, cancer, and pneumonia.
- In advanced CKD (G5), mortality after IS was primarily due to diabetes mellitus, CKD complications, and stroke itself. Stroke was the leading cause of death after HS across all CKD stages.
Conclusions:
- Late-stage CKD patients experience distinct causes of death post-stroke compared to early-stage patients, despite high overall mortality.
- These findings underscore the necessity for developing individualized treatment strategies for stroke patients with advanced CKD to enhance prognosis.
Background:
Stroke is prevalent in patients with chronic kidney disease (CKD) and is associated with high mortality, but the causes of death after stroke among different CKD stages are not well known.
Aims:
We aimed to investigate whether the severity of CKD would impact on the causes of death after first-ever stroke.
Methods:
This retrospective multicenter cohort study included stoke patients with CKD between 2007 and 2012. The cause of death and date of death were ascertained by linking the National Death Registry Database of Taiwan. Clinical outcomes, 1-month, and 1-year mortality rates, and major causes of death were compared according to five CKD stages (G1 to G5) in the ischemic and hemorrhagic stroke separately.
Results:
Of these patients, 9,878 were first-ever ischemic stroke (IS) patients, and 1,387 were first-ever hemorrhagic stroke (HS) patients. Patients with CKD G5 had the highest one-year mortality rate with hazard ratio 5.28 [95%CI, 3.94-7.08] in IS and 3.03 [95%CI, 2.03-4.54] in HS when compared to G1 patients. Leading causes of one-year death after IS were stroke, cancer, and pneumonia in early (G1-3) CKD patients, while diabetes mellitus, CKD, and stroke itself contributed to the major mortality in CKD G5 patients. An inverse association between eGFR decrement and the proportion of deaths caused by stroke itself was observed in CKD G2-5 patients after IS. Stroke was the leading cause of one-year death among all CKD patients after HS.
Conclusions:
Asides from high mortality, late-stage CKD patients had different causes of death from early CKD patients after stroke. This study highlights the need to imply different treatment strategies in late-stage CKD post-stroke patients to improve their prognosis.
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