Abstract P403: Role of Modifiable and Non-modifiable Risk Factors in the Association of Kidney Function With Stroke Risk in Multi-ethnic Study of Atherosclerosis (MESA)

Abstract

Introduction: Persons with chronic kidney disease have up to 8 times higher risk of stroke. A role for shared vascular risk factors, such as aging, sex, hypertension, and diabetes has been implicated in this association. We aim to explore the contribution of non-modifiable and modifiable vascular risk factors to this association. Hypothesis: We hypothesize that non-modifiable and modifiable vascular risk factors could explain part, but not all, of the association between kidney function and incidence of stroke. Methods: We included 6404 participants (mean age 62 yrs, 51% women, 38% white). Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Participants were followed for an average of 12±4 yrs for incidence of stroke. Multiple Cox regression models, adjusted for baseline non-modifiable (age, sex and race) and modifiable (BMI, smoking, SBP, diabetes, cholesterol, alcohol intake, physical activity, and healthy diet score) risk factors were used to estimate the association of kidney function with incidence of stroke. Results: During follow-up, 284 (4.4%) fatal and non-fatal stroke cases were adjudicated. Among them, 233 (3.6%) were non-fatal stroke. Non-modifiable vs. modifiable risk factors were associated with greater reduction in HRs from a crude model for association of each SD lower eGFR with risk of stroke. (25% vs. 12% for non-fatal and 33% vs. 14% for all stroke). Non-modifiable vs. modifiable risk factors were associated with a lower reduction in HRs from a crude model for association of doubling ACR with risk of stroke (6% vs. 12% for both non-fatal and all stroke) (Figure). After adjusting for all factors, worse kidney function remained associated with risk of stroke. Conclusions: Findings suggest that conventional modifiable and non-modifiable vascular risk factors do not fully explain the higher risk of stroke in relation to worse kidney function. This finding warrants exploring other potential novel mechanisms of this association.