Cerebrovascular Disease and Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is an independent risk factor for stroke. Patients with CKD are susceptible to ischemic as well as hemorrhagic stroke. The impairments in the small vessel vasculature, atherosclerotic changes of the large vessels, and coagulation abnormalities probably underlie the specific characteristics of stroke in CKD patients. The clinical outcomes, including functional outcomes and short- and long-term mortality after stroke, are poor in patients with CKD. CKD is defined as a decreased glomerular filtration rate (GFR) and/or increased urine albumin excretion. One or both of these markers were significantly associated with poor functional outcomes and mortality after stroke. Recent studies have suggested that proteinuria/albuminuria is more deeply involved in the clinical outcomes than GFR. The evidence for the most effective management of acute stroke in CKD patients is lacking, and thus, the current treatment for stroke is optimized for individual patients based on their background. In this chapter, the scope of the problem, types of cerebrovascular disease, transient ischemic attack (TIA), and ischemic and hemorrhagic stroke were defined with an emphasis regarding the role of an impaired kidney function on the features of the stroke. The management of stroke in CKD patients is also discussed, although no optimal treatment protocol has yet been established.