Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages

Dad, Taimur; Weiner, Daniel E.

doi:10.1016/j.semnephrol.2015.06.003

Cited by 79 publications

(65 citation statements)

References 111 publications

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“…12 However, for CKD patients on dialysis, there is a higher risk of intracerebral haemorrhage compared to the general population when administering tissue plasminogen activator, possibly due to endothelial and platelet dysfunction in these patients. 12 The efficacy of mechanical thrombectomy as an alternative to thrombolysis in CKD patients is yet to be adequately established. Reduction of modifiable risk factors and, optimally, stroke prevention are attractive management strategies in CKD patients.…”

Section: Altered Mental Statusmentioning

confidence: 99%

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Neurological complications in chronic kidney disease

Arnold

Issar

Krishnan

et al. 2016

JRSM Cardiovascular Disease

171

129

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Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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Section: Altered Mental Statusmentioning

confidence: 99%

“…Evidence suggests warfarin is appropriate for stage 3 CKD but not dialysis patients and that anti-coagulation reduces the risk of stroke. 12 …”

Section: Altered Mental Statusmentioning

confidence: 99%

Neurological complications in chronic kidney disease

Arnold

Issar

Krishnan

et al. 2016

JRSM Cardiovascular Disease

171

129

View full text Add to dashboard Cite

show abstract

“…Patients with chronic kidney disease (CKD) have markedly increased rates of cardiovascular (Foley et al 1995;Lai et al 2015) and cerebrovascular disease (Dad and Weiner 2015) and mortality even before reaching end-stage renal disease (ESRD). Therefore, it is critical to identify early biomarkers predicting major adverse cardiovascular and cerebrovascular events (MACCEs) or survival in patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

Higher Serum Levels of Osteoglycin Are Associated with All-Cause Mortality and Cardiovascular and Cerebrovascular Events in Patients with Advanced Chronic Kidney Disease

Baek

Hui

Kang

et al. 2017

Tohoku J. Exp. Med.

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Patients with chronic kidney disease (CKD) have markedly increased rates of major adverse cardiovascular and cerebrovascular events (MACCEs) and mortality. Therefore, identifying early biomarkers predicting clinical outcomes in patients with CKD is critical. We aimed to determine whether osteoglycin, a basic component of the vascular extracellular matrix, was associated with MACCEs or all-cause mortality, using data from a prospective randomized controlled study, K-STAR (Kremezin STudy Against Renal disease progression in Korea: NCT 00860431). A total of 383 patients (mean age: 56.4 years, men/women = 252/131) with CKD stage 3 to 4 from the original trial were enrolled in the present study. We measured serum osteoglycin level and examined the impact of osteoglycin on clinical outcomes. The mean value of osteoglycin levels was 13.3 ± 9.4 ng/mL (healthy control: 5.3 ± 2.1 ng/mL). In multivariable analysis, lower levels of proteinuria and hemoglobin and higher levels of C-reactive protein were significantly associated with higher osteoglycin levels. Estimated glomerular filtration rate was not related to osteoglycin level. During a mean follow-up period of 56 months, 25 deaths, 61 MACCEs, and 76 composite outcomes (all-cause mortality or MACCEs) occurred. In the non-diabetic group, each 1-ng/mL increase in serum osteoglycin was associated with all-cause mortality and composite outcome (hazard ratio [HR] = 1.058, P = 0.031; HR = 1.041, P = 0.036). However, osteoglycin levels were not associated with mortality, MACCEs, or composite outcome in the diabetic group. Our results indicate that serum osteoglycin is a potential predictor of adverse outcomes in patients with CKD.

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“…There is currently no restriction in using vitamin K antagonists (VKA) in non-ESRD CKD [11]. The classic treatment of AF with VKA (namely warfarin) significantly reduces the risk of stroke in non-end stage CKD, without significantly impacting the risk for major bleeding [12].…”

Section: Ischaemic Strokementioning

confidence: 99%

“…In the absence of RCTs regarding stroke prevention in dialysis patients with AF, the decision to use oral anticoagulants should be made on an individual basis [11]. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) controversies report published in September 2017 is the first official taskforce that discusses the existing observational studies that examine warfarin use and associated stroke and bleeding risks in adults with CKD-5D and AF [17].…”

Section: Ischaemic Strokementioning

confidence: 99%

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

Bîlha¹,

Burlacu²,

Siriopol³

et al. 2018

Cerebrovasc Dis

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Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking. Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe in non-end stage CKD, but it should be individualized and preferably based on thromboembolic and bleeding stratification algorithms. Non-vitamin K antagonist oral anticoagulants with definite dose adjustment are generally preferred over vitamin K antagonists in mild and moderate CKD and their indications have started being extended to severe CKD and dialysis also. Aspirin, but not clopidogrel, has limited indications for reducing the risk for atherothrombotic events in CKD due to its increased bleeding risk. Carotid endarterectomy has shown promising results for stroke risk reduction in CKD patients with high-grade symptomatic carotid stenosis. The medical treatment of arterial hypertension in CKD often fails to efficiently lower blood pressure values, but recent data regarding the use of interventional procedures such as renal denervation, baroreflex activation therapy or renal artery stenting are encouraging. Key Messages: In the absence of clear guidelines and protocols, primary prevention of stroke in CKD patients remains a subtle art in the hands of the clinicians. Nevertheless, refraining CKD patients from standard therapies often worsens their prognosis.

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Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages

Cited by 79 publications

References 111 publications

Neurological complications in chronic kidney disease

Neurological complications in chronic kidney disease

Higher Serum Levels of Osteoglycin Are Associated with All-Cause Mortality and Cardiovascular and Cerebrovascular Events in Patients with Advanced Chronic Kidney Disease

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

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