Stroke Subtype Among Individuals With Chronic Kidney Disease

Area of Science:

• Nephrology
• Neurology
• Epidemiology

Background:

• Chronic kidney disease (CKD) is a known risk factor for acute ischemic stroke.
• The association between specific ischemic stroke subtypes and CKD stage requires further clarification.

Purpose of the Study:

• To investigate the relationship between different ischemic stroke subtypes (cardioembolic, arterial, lacunar, other) classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST).
• To assess how these stroke subtypes correlate with various stages of chronic kidney disease (CKD).

Main Methods:

• A retrospective cohort study included 17,434 adult patients with acute ischemic stroke in Ontario, Canada (2002-2013).
• Kidney function was categorized by estimated glomerular filtration rate (eGFR) levels (≥60, 30-59, <30 mL/min/1.73 m²), or maintenance dialysis.
• Ischemic stroke subtypes were classified using the TOAST criteria; adjusted regression models were employed.

Main Results:

• Cardioembolic stroke was more prevalent in patients with non-dialysis-dependent CKD (eGFR 30-59 and <30 mL/min/1.73 m²).
• Lacunar stroke was less common in patients with reduced kidney function (eGFR 30-59 and <30 mL/min/1.73 m²) compared to those with eGFR ≥60 mL/min/1.73 m².
• Age stratification revealed lacunar strokes were more frequent in younger patients (<65 years) and cardioembolic strokes in older patients (≥65 years).

Conclusions:

• Non-dialysis CKD is associated with an elevated risk of cardioembolic stroke.
• Higher kidney function (eGFR ≥60 mL/min/1.73 m²) is associated with a higher risk of lacunar stroke.
• Detailed stroke subtyping in CKD patients may offer insights into mechanisms and refine treatment strategies.