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Stroke incidence and chronic kidney disease: A hospital-based prospective cohort study

Minako Wakasugi1, Akio Yokoseki1, Masakazu Wada2

  • 1Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Nephrology (Carlton, Vic.)
|April 30, 2022
PubMed

Insights

Chronic kidney disease (CKD) increases stroke risk, particularly in later stages and with proteinuria. Patients with stage 5D CKD face a fourfold higher stroke risk, underscoring the need for proactive cardiovascular management in CKD populations.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Epidemiology

Background:

  • Chronic kidney disease (CKD) is a growing public health concern associated with increased cardiovascular morbidity.
  • Understanding the specific risks of stroke across different stages of CKD and in the presence of proteinuria is crucial for risk stratification and management.
  • Traditional cardiovascular risk factors do not fully explain the elevated stroke risk observed in CKD patients.

Purpose of the Study:

  • To investigate stroke incidence and subtypes in relation to chronic kidney disease (CKD) stages.
  • To determine if CKD patients with or without proteinuria have an independent risk of stroke.
  • To provide precise stroke risk estimates by CKD stage, considering competing risks of mortality.

Main Methods:

  • A prospective cohort study involving 2023 participants from the Project in Sado for Total Health.
  • Patient data included CKD status (stages 1-5D) and presence or absence of proteinuria.
  • Stroke incidence, subtypes, and mortality were monitored over a median follow-up of 5.7 years.

Main Results:

  • CKD patients with proteinuria and those with stage 5D CKD exhibited significantly higher stroke risks compared to non-CKD individuals.
  • Stage 1-2 CKD and stage G3-5 CKD with proteinuria showed elevated stroke risk (HRs 2.97 and 2.50, respectively).
  • Stroke risk remained significant even after adjusting for traditional cardiovascular risk factors and competing mortality.

Conclusions:

  • CKD is an independent risk factor for stroke, with risk escalating in advanced stages and with proteinuria.
  • CKD stage 5D patients demonstrated a fourfold increased stroke risk, while those with proteinuria had a twofold higher risk.
  • These findings highlight the critical need for aggressive cardiovascular risk management in patients with chronic kidney disease, especially those with proteinuria or end-stage renal disease.
Abstract

Keywords:
CKDclinical epidemiologydialysishypertensionproteinuriastroke

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