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Patients With CKD at Elevated Risk of Kidney Failure and Acute Ischemic Stroke
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Key Takeaways
- CKD patients have an elevated risk of acute ischemic stroke, linked to advanced CKD stages and higher KFRE scores.
- The study involved 14,794 CKD patients, primarily of Chinese descent, with a median age of 73 years.
Additional risk factors included older age and advanced chronic kidney disease (CKD) stage.
A study abstract published in the American Heart Association and American Stroke Association’s journal Stroke shows that patients with chronic kidney disease (CKD) are at an elevated risk of suffering from an acute ischemic stroke. With these findings, the authors suggest that new measures, including implementing Kidney Failure Risk Equation (KFRE) guidelines within the CKD space, may serve as a valuable tool in the assessment of stroke risk for this patient population.
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Both CKD and ischemic stroke are associated with significant global disease burdens and share common risk factors, according to the study authors. Because of this, understanding the impact CKD can have on stroke incidence is necessary to improve patients’ outcomes.
The authors explained that, traditionally, the severity of CKD can be graded using the estimated glomerular filtration rate (eGFR); however, KFRE—which also includes age, sex, eGFR, and the urine albumin creatinine ratio—has shown to be a stronger, more robust tool to predict the disease’s progression to end-stage kidney disease.
For this study, the investigators aimed to evaluate if CKD severity, as assessed by the above parameters, is associated with incident acute ischemic stroke. A total of 14,794 consecutive patients (median age: 73 years; IQR = 14) with CKD who were receiving care within the National University Health System from March 2022 to September 2023 were enrolled and included in the analysis. Patients who had a previous history of ischemic stroke or transient ischemic attack were ineligible for participation. Most of the patients were of Chinese descent (n = 10,759; 73.5%), and a minority were women (n = 6251; 42.3%).
The investigators defined CKD severity by eGFR calculated with the Chronic Kidney Disease Epidemiology Collaboration and as per the Kidney Disease Improving Global Outcomes guidelines. Additionally, 2-year and 5-year risk of kidney failure was estimated by the 4-variable KFRE, and the Cox proportional hazards model was utilized to assess the relationship between CKD stage and KFRE scores with acute ischemic stroke.
Approximately 1.05% (n = 155) of patients had experienced an acute ischemic stroke, with the median days-to-stroke being about 265 days (IQR = 242). Older age (P < .001), ischemic heart disease (P < .001), and KFRE strata (P = .0018) were associated with ischemic stroke. Additionally, advanced CKD stages 4 through 5 were associated with ischemic stroke (P = .0013), with the authors observing the risk of acute stroke increasing with advanced stage compared with patients who had CKD stages 1 through 3b (HR 1.70; 95%CI: 1.14-2.53).
Further, the investigators also observed an approximate 10% increase in both 2-year (HR: 1.38; 95% CI: 1.17-1.63) and 5-year (HR: 1.20; 95% CI: 1.10-1.31) kidney failure risks that corresponded to significantly higher risks of ischemic stroke. Even after adjustments were made for age, gender, ethnicity, comorbidities, lipid parameters, and HbA1c, these associations remained significant, according to the authors.
With these findings, the investigators conclude 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. Although these increases are relatively small, the authors emphasized that developments, such as implementing KFRE guidelines in CKD management, may prove to be an effective method in assessing the risk of ischemic stroke.
