chronic Kidney Disease Linked to Increased Risk of Ischemic Stroke
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- chronic Kidney Disease Linked to Increased Risk of Ischemic Stroke
Patients with chronic kidney disease (CKD) face an elevated risk of suffering an acute ischemic stroke, according to a study published in the American Heart Association and American Stroke Association’s journal, Stroke. The research, conducted between March 2022 and September 2023, suggests that implementing Kidney Failure Risk Equation (KFRE) guidelines could be a valuable tool in assessing stroke risk for this patient population. The study involved 14,794 patients receiving care within the National University Health System.
The connection between chronic kidney disease and the increased likelihood of ischemic stroke is a growing concern for medical professionals. Ischemic stroke, a condition where blood flow to the brain is blocked, shares common risk factors with CKD, making individuals with kidney disease particularly vulnerable. Understanding this link is crucial for developing effective prevention and treatment strategies.
Understanding CKD Severity and Stroke Risk
Traditionally, the severity of CKD has been assessed using the estimated glomerular filtration rate (eGFR). However, the Kidney Failure Risk Equation (KFRE), which incorporates age, sex, eGFR, and the urine albumin creatinine ratio, has proven to be a more robust predictor of the disease’s progression to end-stage kidney disease. This study aimed to evaluate whether CKD severity, as assessed by these parameters, is associated with the incidence of acute ischemic stroke.
The study enrolled 14,794 consecutive patients with CKD (median age: 73 years; IQR = 14) receiving care within the National University Health System from march 2022 to September 2023. Patients with a prior history of ischemic stroke or transient ischemic attack were excluded from participation.The majority of patients were of Chinese descent (n = 10,759; 73.5%), and a minority were women (n = 6251; 42.3%).
Researchers defined CKD severity by eGFR, calculated using the Chronic Kidney Disease Epidemiology collaboration, and according to the Kidney Disease Improving Global Outcomes guidelines. They also estimated the two-year and five-year risk of kidney failure using the four-variable KFRE. The Cox proportional hazards model was then utilized to assess the relationship between CKD stage and KFRE scores with acute ischemic stroke.
Key findings: CKD and Stroke Incidence
the study revealed that approximately 1.05% (n = 155) of patients experienced an acute ischemic stroke, with the median days-to-stroke being about 265 days (IQR = 242). Older age (P < .0001), diabetes (P = .0018),and prior heart failure (P = .014) were substantially associated with ischemic stroke. Advanced CKD stages 4 through 5 were also associated with ischemic stroke (P = .0013). The risk of acute stroke increased with advanced CKD stage compared to patients with CKD stages 1 through 3b, with a hazard ratio (HR) of 1.70 (95% CI: 1.14-2.53).
Moreover, the investigators observed that an approximate 10% increase in both two-year (HR: 1.38; 95% CI: 1.17-1.63) and five-year (HR: 1.20; 95% CI: 1.10-1.31) kidney failure risks corresponded to substantially higher risks of ischemic stroke. These associations remained significant even after adjustments were made for age, gender, ethnicity, comorbidities, lipid parameters, and HbA1c.
Implications and Future Directions
The study’s findings underscore the elevated risk of kidney failure and acute ischemic stroke in patients with CKD. While the increases in risk are relatively small, the authors emphasize the potential effectiveness of implementing KFRE guidelines in CKD management to assess the risk of ischemic stroke. This proactive approach could lead to earlier interventions and improved outcomes for this vulnerable population.
The researchers concluded that:
patients with CKD are at an elevated risk of kidney failure. Additionally, this population is at an increased risk of suffering from an acute ischemic stroke.
They further suggested that:
developments, such as implementing KFRE guidelines in CKD management, may prove to be an effective method in assessing the risk of ischemic stroke.
Further research is needed to explore the optimal strategies for implementing KFRE guidelines and to evaluate the impact of these strategies on stroke prevention in patients with CKD. The study highlights the importance of a comprehensive approach to managing CKD, with a focus on identifying and mitigating the risk of cardiovascular events, including ischemic stroke.
The study is referenced as:
Tan BY, Tan YY, Lim S, et al. Abstract TP294: The Impact of Chronic Kidney Disease Severity on Incident Acute Ischemic stroke.Stroke. 2025;56(supplement 1).doi:10.1161/str.56.suppl_1.TP294
Is Your Kidney Health Secretly Raising Your Stroke Risk? A Leading Nephrologist Explains
Did you know that chronic kidney disease (CKD) significantly increases your chances of suffering an ischemic stroke? This alarming connection is often overlooked, but understanding the relationship between kidney health and stroke risk is crucial for proactive prevention. To shed light on this critical issue, we interviewed Dr. Evelyn Reed, a renowned nephrologist and cardiovascular specialist, to uncover the hidden dangers and discuss effective strategies for safeguarding your health.
World-Today-News: Dr. Reed, thank you for joining us. Let’s begin with the fundamentals: what is the precise relationship between CKD and ischemic stroke?
Dr. Reed: The link between chronic kidney disease and ischemic stroke is a powerful one, often underestimated. CKD, marked by a progressive decline in kidney function, shares multiple risk factors with ischemic stroke—a stroke caused by a blood clot obstructing blood flow to the brain. These shared risk factors, including hypertension (high blood pressure), type 2 diabetes mellitus, and atherosclerosis (hardening of the arteries), create a hazardous synergy. The damage inflicted on the kidneys frequently extends to the vascular system throughout the body, making individuals with CKD exceptionally vulnerable to stroke.
World-today-News: The recent study highlighted the Kidney Failure Risk Equation (KFRE). Can you elaborate on its role in assessing stroke risk for CKD patients?
Dr. Reed: The KFRE represents a considerable advancement in risk assessment. Customary methods, primarily relying on the estimated glomerular filtration rate (eGFR), frequently enough fail to comprehensively capture the complexity of CKD. The KFRE, however, provides a more nuanced picture by incorporating age, sex, eGFR, and the urine albumin-creatinine ratio. This broader evaluation offers a more accurate prediction of CKD progression and its associated stroke risk. By identifying high-risk individuals earlier, we can implement preventative measures more effectively. Early intervention is vital,and the KFRE significantly improves our ability to determine appropriate preventative strategies.
World-Today-News: The study showed a strong association between advanced CKD stages (stages 4-5) and ischemic stroke.what are the underlying mechanisms driving this association?
Dr. Reed: Several factors contribute to this increased risk. Advanced CKD often triggers systemic inflammation, damaging blood vessels and increasing the likelihood of clot formation. In later CKD stages, reduced erythropoietin production—a hormone critical for red blood cell formation—leads to anemia. Anemia diminishes oxygen delivery to the brain, further elevating stroke vulnerability. These interacting factors combine to create a significantly heightened risk of ischemic events in individuals with severe CKD.
World-Today-News: How do comorbidities like diabetes and heart failure influence stroke risk in CKD patients?
Dr. Reed: The presence of multiple comorbidities significantly amplifies the risk. Diabetes,as a notable example,frequently enough damages blood vessels,setting the stage for clot formation. Heart failure’s impact on vascular health shares similar detrimental effects. These conditions, alongside CKD, create a especially perilous combination. The accumulation of multiple risk factors necessitates a proactive and comprehensive management approach.
World-Today-news: What practical steps can individuals with CKD take to mitigate their stroke risk?
Dr.Reed: A multifaceted approach is essential:
Stringent blood pressure control: Maintaining blood pressure within healthy parameters is paramount.
Optimal diabetes management: Strict control of blood glucose levels is crucial.
Lipid management: Effective management of cholesterol and triglyceride levels is vital.
Lifestyle modifications: Regular exercise, a balanced diet rich in fruits and vegetables, and smoking cessation are highly beneficial.
* Regular monitoring: Consistent monitoring of kidney function and cardiovascular health is non-negotiable.
Beyond these, regular consultations with a nephrologist specializing in cardiovascular risk would be greatly beneficial.
World-Today-News: what are some emerging developments in this field beyond the KFRE?
Dr. Reed: Research into the CKD-stroke connection is ongoing. New biomarkers and improved risk stratification tools are constantly evolving, offering more accurate risk predictions and enhanced prevention strategies. The focus is expanding to encompass inflammation and other cardiovascular biomarkers for a more holistic risk assessment. This comprehensive approach ensures that we can identify and treat those most at risk effectively.
World-Today-news: What is your concluding message for our readers regarding this crucial connection?
Dr. Reed: The link between chronic kidney disease and ischemic stroke is undeniable and demands attention. Early detection, vigilant management of co-existing conditions, and proactive lifestyle changes can significantly reduce risk. Your kidney health directly impacts your cardiovascular health; proactive care is essential for a healthier future. don’t hesitate to seek regular checkups and discuss your risk factors with your healthcare provider.
we encourage you to share your thoughts and experiences in the comments below. Let’s work together to raise awareness of this critical health connection!