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Updated: May 27, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Severity of Chronic Kidney Disease as Assessed by the Kidney Failure Risk Equation Is Associated With Incident Acute
Benjamin Y Q Tan1,2,3,4, Yong Yi Tan5, Sean Shi-An Lim5
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Insights
Patients with chronic kidney disease (CKD) have a higher risk of stroke. The kidney failure risk equation (KFRE) can help predict this risk in CKD patients.
Area of Science:
- Nephrology
- Neurology
- Epidemiology
Background:
- Stroke and chronic kidney disease (CKD) are significant global health burdens.
- Emerging evidence suggests a link between CKD and increased stroke risk.
- Current stroke risk assessment tools are limited for CKD patients.
Purpose of the Study:
- To investigate the utility of the kidney failure risk equation (KFRE) in predicting ischemic stroke risk among CKD patients.
- To determine if KFRE scores are associated with incident ischemic stroke in a CKD cohort.
Main Methods:
- Retrospective analysis of 14,794 CKD patients from a healthcare registry.
- Exclusion of patients with prior stroke, end-stage kidney disease, or kidney transplants.
- Cox proportional hazards models used to assess the association between 2-year and 5-year 4-variable KFRE scores and ischemic stroke.
Main Results:
- 155 patients (1.05%) experienced ischemic stroke during a median follow-up of 509 days.
- Both 2-year (HR: 1.38) and 5-year (HR: 1.20) KFRE scores were significantly associated with increased ischemic stroke risk.
- Associations remained significant after adjusting for demographics, comorbidities, and other clinical parameters.
Conclusions:
- CKD patients with a high risk of kidney failure also have a significantly elevated risk of ischemic stroke.
- The KFRE may be a valuable tool for integrated risk assessment in CKD management.
- Further prospective studies are needed to validate these findings.
Aim:
Stroke is a leading cause of death and disability, with substantial healthcare implications. Chronic kidney disease (CKD) is similarly impactful, and emerging evidence links CKD to a higher stroke risk. Despite this, stroke risk assessment in CKD patients remains limited. This study explores the kidney failure risk equation (KFRE) as a predictive tool for ischaemic stroke in CKD patients.
Methods:
This retrospective cohort study analysed CKD patients from a healthcare registry, excluding those with prior stroke, end-stage kidney disease, or kidney transplants. Acute ischemic stroke was the primary outcome, with deaths censored. Cox proportional hazards models evaluated associations between the 2-year and 5-year 4-variable KFRE scores and stroke risk.
Results:
A total of 14,794 consecutive patients were included, with a median follow-up of 509 days. The median age of the cohort was 73 years (IQR:14 years), with 6251 females(42.3%), and the majority being of Chinese ethnicity (n = 10 759,73.5%). During the follow-up period, 155 patients (1.05%) experienced an ischemic stroke event, with a median time to stroke of 265 days (IQR:242 days). The 2-year (HR: 1.38 per 10% increase, 95% CI: [1.17-1.63], p < 0.001) and 5-year (HR:1.20 per 10% increase, 95% CI: [1.10-1.31], p < 0.001) 4-variable KFRE scores were significantly associated with an increased risk of ischemic stroke. These associations remained significant after adjusting for patient demographics, comorbidities, advanced CKD stage, glycated haemoglobin and lipid parameters.
Conclusion:
CKD patients at elevated risk of kidney failure also face a significantly increased risk of acute ischaemic stroke. The KFRE could potentially be integrated into CKD management to assess this risk. Future large prospective cohort studies are necessary to validate these findings.
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