Abstract
With both an aging population and greater post-stroke survival, multimorbidity is a growing healthcare challenge, affecting over 40% of stroke patients, and rising rapidly and predictably with increasing age. Commonly defined as the co-occurrence of two or more chronic conditions, multimorbidity burden is a strong adverse prognostic factor, associated with greater short- and long-term stroke mortality, worse rehabilitation outcomes, and reduced use of secondary prevention. Chronic kidney disease can be considered as the archetypal comorbidity, being age-dependent and also affecting about 40% of stroke patients. Chronic kidney disease and stroke share very similar traditional cardiovascular risk factor profiles such as hypertension and diabetes, though novel chronic kidney disease-specific risk factors such as inflammation and oxidative stress have also been proposed. Using chronic kidney disease as an exemplar condition, we explore the mechanisms of risk in multimorbidity, implications for management, impact on stroke severity, and downstream consequences such as post-stroke cognitive impairment and dementia.
Highlights
The term ‘‘multimorbidity’’ is typically defined as the presence of two or more long-term conditions within an individual.[1]
chronic kidney disease (CKD) is a good example of this phenomenon because, as we will demonstrate, it is under-recognized, increasing in prevalence, associated with both traditional vascular risk factors as well as non-traditional ones, and it can potentially impact every stage of stroke presentation, diagnosis, treatment, and outcome
Patients with CKD appeared to have a 36% greater risk of stroke than in those with normal renal function in multivariate-adjusted analysis, this risk association varied considerably depending on the way in which hypertension was adjusted for (Figure 2)
Summary
The term ‘‘multimorbidity’’ is typically defined as the presence of two or more long-term conditions within an individual.[1]. CKD is a good example of this phenomenon because, as we will demonstrate, it is under-recognized, increasing in prevalence, associated with both traditional vascular risk factors as well as non-traditional ones, and it can potentially impact every stage of stroke presentation, diagnosis, treatment, and outcome
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