Impact of prior stroke on major clinical outcome in chronic kidney disease: the Salford kidney cohort study

James Tollitt,Emma Flanagan,Craig Smith,Aghogho Odudu,Philip A Kalra,Rajkumar Chinnadurai

doi:10.1186/s12882-019-1614-5

James Tollitt, Emma Flanagan + Show 4 more

Open Access

https://doi.org/10.1186/s12882-019-1614-5

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Abstract

BackgroundChronic kidney disease (CKD) is an independent risk factor for stroke in the general population. The impact of prior stroke on major clinical outcomes in CKD populations is poorly characterised.MethodsThe Salford Kidney Study is a UK prospective cohort of more than 3000 patients recruited since 2002 and followed until March 2018. Multivariable Cox regression examined associations of stroke at two time points; cohort inception, and at dialysis initiation, with risks of death, non-fatal cardiovascular events (NFCVE) and end stage renal disease (ESRD).Results277 (9.1%) of 3060 patients suffered a prior stroke and this was associated with mortality, ESRD and future NFCVE after cardiovascular risk factor adjustments. Median survival for prior stroke patients was 40 months vs 77 months in patients without a stroke. Prior stroke was independently associated with mortality (HR 1.20 95%CI 1.0–1.43, p = 0.05). Of 579 patients who reached ESRD and commenced dialysis, a prior stroke (N = 48) was independently associated with mortality. Median survival for the prior stroke group was 29 months compared with 50 months for the non-stroke group. Only 70 and 75% of patients who had suffered an ischaemic stroke were prescribed antiplatelets or statins respectively.ConclusionsA diagnosis of stroke is strongly and independently associated with several adverse clinical outcomes for patients with CKD. Prior stroke profoundly alters cardiovascular risk in CKD patients. Greater attention to primary and secondary preventive strategies is warranted which may improve these outcomes.

Highlights

Chronic kidney disease (CKD) is an independent risk factor for stroke in the general population
The study used data from the Salford Kidney Study (SKS), previously known as the Chronic Renal Insufficiency Standards Implementation Study (CRISIS), a longitudinal epidemiological cohort study of more than 3000 adults with all-cause Non dialysis chronic kidney disease (ND-CKD) recruited since October 2002 [11, 12]
Where stroke aetiology was available, 89% of strokes were ischaemic in nature which is proportionally similar to general population statistics [17]

Summary

Introduction

Chronic kidney disease (CKD) is an independent risk factor for stroke in the general population. The impact of prior stroke on major clinical outcomes in CKD populations is poorly characterised. Stroke and chronic kidney disease (CKD) are major world health concerns but their interaction is rarely considered. Cerebrovascular disease is the third leading cause of death in the UK [1]. Due to ageing populations and improved survival after stroke [2], more patients are living with these two comorbidities. Patients with CKD are more likely to suffer severe and recurrent strokes [3, 4]. For every 10 mL/min/1.73m2 reduction in glomerular filtration rate (GFR), the risk of stroke increases by 7% [5]. Dialysis patients have an elevated risk of stroke

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