Stroke and Risks of Development and Progression of Kidney Diseases and End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

Abstract

BackgroundThere is little information about the association between stroke and kidney diseases. We aimed to investigate the impact of stroke on long-term renal outcomes.MethodsIn this large population-based retrospective cohort study, we identified 100,353 subjects registered in the National Health Insurance Research Database of Taiwan from January 1, 2000, through December 31, 2012, including 33,451 stroke patients and 66,902 age-, sex- and Charlson’s comorbidity index score-matched controls.ResultsThe incidence rate of chronic kidney disease (CKD) was higher in the stroke than in the control cohort (17.5 vs. 9.06 per 1000 person-years). After multivariate adjustment, the risk of developing CKD was significantly higher in patients with stroke (adjusted hazard ratio [aHR] 1.43, 95% confidence interval [CI] 1.36–1.50, P<0.001). Subgroup analysis showed that stroke patients <50 years (aHR 1.61, P<0.001) and those with concomitant diabetes mellitus (aHR 2.12, P<0.001), hyperlipidemia (aHR 1.53, P<0.001) or gout (aHR 1.84, P<0.001) were at higher risk of incident CKD. Additionally, the risks of progression to advanced CKD and end-stage renal disease (ESRD) were significantly higher for stroke patients (aHRs, 1.22 and 1.30; P = 0.04 and P = 0.008, respectively), independent of age, sex, comorbidities and long-term medications.ConclusionsStroke is associated with higher risks for incident CKD, decline in renal function and ESRD. Younger stroke patients, as well as those with concomitant diabetes mellitus, hyperlipidemia or gout are at greater risk for kidney diseases.

Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis

“…[7][8][9] Our previous cohort study reported a substantial correlation between stroke and higher risks for CKD, a decline in the renal function, and ESRD. 10 In the similar long-term cohort study, we also reported that both migraine and traumatic brain injury are independent risk factors for CKD or ESRD. 11,12 Perhaps, the interaction between these neuropeptides and CKD is mediated by the activation of renal sympathoexcitation via vaso-afferent nerve activation.…”

“…In our previous study, we reported that stroke patients with diabetes, gout or hyperlipidaemia could be at higher risk of the CKD progression . We used the propensity score matching to control potential confounding factors, including comorbidities, medication and biochemical data (Table ).…”

“…In our previous study, we reported that stroke patients with diabetes, gout or hyperlipidaemia could be at higher risk of the CKD progression. 10 We used the propensity score matching to control potential confounding factors, including comorbidities, medication and biochemical data ( Table 1). In this study, we determined that rt-PA can attenuate the risk of the chronic renal progression in patients with acute ischemic stroke during the 5-year follow-up period ( Fig.…”

“…In contrast, cerebrovascular diseases could also correlate with CKD or end‐stage renal disease (ESRD) . Our previous cohort study reported a substantial correlation between stroke and higher risks for CKD, a decline in the renal function, and ESRD . In the similar long‐term cohort study, we also reported that both migraine and traumatic brain injury are independent risk factors for CKD or ESRD .…”

Hydroxychloroquine Use and Risk of CKD in Patients with Rheumatoid Arthritis

“…The primary outcome was incident CKD defined by at least three ICD-9-CM codes for at least 3 months (Supplemental Table 1) (12)(13)(14)(15). Potential relevant confounding variables included demographics, important comorbidities identified by at least three diagnosis codes within 1 year before rheumatoid arthritis diagnosis (Supplemental Table 1), and long-term medications, such as antidiabetic drugs, diuretics, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and nonsteroidal antiinflammatory drugs (NSAIDs).…”