Abstract
BackgroundStroke is prevalent in patients with chronic kidney disease (CKD) and is associated with high mortality, but the causes of death after stroke among different CKD stages are not well known.AimsWe aimed to investigate whether the severity of CKD would impact on the causes of death after first-ever stroke.MethodsThis retrospective multicenter cohort study included stoke patients with CKD between 2007 and 2012. The cause of death and date of death were ascertained by linking the National Death Registry Database of Taiwan. Clinical outcomes, 1-month, and 1-year mortality rates, and major causes of death were compared according to five CKD stages (G1 to G5) in the ischemic and hemorrhagic stroke separately.ResultsOf these patients, 9,878 were first-ever ischemic stroke (IS) patients, and 1,387 were first-ever hemorrhagic stroke (HS) patients. Patients with CKD G5 had the highest one-year mortality rate with hazard ratio 5.28 [95%CI, 3.94–7.08] in IS and 3.03 [95%CI, 2.03–4.54] in HS when compared to G1 patients. Leading causes of one-year death after IS were stroke, cancer, and pneumonia in early (G1-3) CKD patients, while diabetes mellitus, CKD, and stroke itself contributed to the major mortality in CKD G5 patients. An inverse association between eGFR decrement and the proportion of deaths caused by stroke itself was observed in CKD G2-5 patients after IS. Stroke was the leading cause of one-year death among all CKD patients after HS.ConclusionsAsides from high mortality, late-stage CKD patients had different causes of death from early CKD patients after stroke. This study highlights the need to imply different treatment strategies in late-stage CKD post-stroke patients to improve their prognosis.
Highlights
Stroke is the leading cause of mortality and disability worldwide [1, 2]
We aimed to investigate whether the severity of chronic kidney disease (CKD) would impact on the causes of death after first-ever stroke
Patients with CKD G5 had the highest one-year mortality rate with hazard ratio 5.28 [95%CI, 3.94–7.08] in ischemic stroke (IS) and 3.03 [95%CI, 2.03–4.54] in hemorrhagic stroke (HS) when compared to G1 patients
Summary
Chronic kidney disease (CKD) has been recognized as an important risk factor both for ischemic stroke (IS) and hemorrhagic stroke (HS) [3]. While the mortality after stroke has declined over time due to better control of modifiable risk factors and better in-hospital management [7, 8], the death rate after stroke in CKD patients remains high, especially in those who progressed to late CKD [9, 10]. There has been no study discussing the impact of different CKD stages on the causes of death in post-stroke patients. Stroke is prevalent in patients with chronic kidney disease (CKD) and is associated with high mortality, but the causes of death after stroke among different CKD stages are not well known
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