The Risk of Stroke in Kidney Transplant Recipients with End-Stage Kidney Disease

Abstract

Background: The incidence of stroke after kidney transplantation is poorly understood. Our study aimed to determine the incidence and predictors of stroke as well as mortality from stroke in kidney transplant recipients (KTRs). Methods: This retrospective cohort study used the National Health Insurance Research Database in Taiwan to study KTRs (N = 4635), patients with end-stage renal disease (ESRD; N = 69,297), and patients from the general population who were chronic kidney disease (CKD)-free and matched by comorbidities (N = 69,297) for the years 2000 through 2010. The risk of stroke was analyzed using univariate and multivariate Cox regression models and compared between study cohorts. Findings: Compared with the ESRD subgroup, KTRs had a significantly lower risk of overall stroke (adjusted hazard ratio (aHR) = 0.37, 95% confidence interval (CI) = 0.31–0.44), ischemic stroke (aHR = 0.45, 95% CI = 0.37–0.55), and hemorrhagic stroke (aHR = 0.20, 95% CI = 0.14–0.29). The risk patterns for each type of stroke in the KTR group were not significantly different than those of the CKD-free control subgroup. The predictors of stroke were age and diabetes in KTRs. All forms of stroke after transplantation independently predicted an increased risk of subsequent mortality, and the strongest risk was related to hemorrhagic events. Interpretation: KTRs had a lower risk of stroke than ESRD patients, but this risk was not significantly different from that of the CKD-free comorbidities-matched general population group. Although stroke was relatively uncommon among cardiovascular events, it predicted unfavorable outcome in KTRs.

Chronic kidney disease as a risk factor for acute stroke

“…Низкий уровень рСКФ при поступлении (менее 15 мл/мин/1,73 м 2 ) увеличивал риск краткосрочной (1 мес) смертности в 3 раза, а долгосрочной (1 год) смертности -в 4 раза по сравнению с пациентами с рСКФ не менее 90 мл/мин/1,73 м 2 или находящимися на диализе [64]. В других исследованиях сообщалось, что протеинурия, но не низкая рСКФ, является независимым предиктором высокого риска неврологического ухудшения, инвалидности и смерти [65].…”

“…По данным S.T. Huang et al [65], в азиатской популяции общая кумулятивная частота ИИ составила 1,5%, что значительно меньше, чем в западной когорте. Отчасти это связано с тем, что западная когорта состояла из более пожилых пациентов с коморбидностью.…”

“…Отчасти это связано с тем, что западная когорта состояла из более пожилых пациентов с коморбидностью. Прогностическими факторами развития ГИ были пожилой возраст, СД и заболевания периферических сосудов [8, 65,66]. ГИ был зарегистрирован у 36,84% пациентов после ТП.…”

An Approach to Neurological Disorders in a Kidney Transplant Recipient

“…Various factors like long-term use of steroids, hypertension, diabetes mellitus, smoking, old age, poor graft function, obesity, dyslipidemia, and peripheral arterial disease contribute to accelerated atherosclerosis and increased risk of stroke in a KTR. Patients with polycystic kidney disease are at a higher risk of developing a hemorrhagic stroke (49). In a KTR with ischemic stroke, other possibilities like fungal infections (aspergillosis and mucormycosis) should also be excluded because the hyphae can invade cerebral arteries with distal embolization.…”

Application of Artificial Intelligence Techniques to Predict Survival in Kidney Transplantation: A Review

“…Scientific literature includes many studies that apply these techniques to data pertaining to kidney transplant. For example, in [12] the rate of kidney failure after transplant in Europe between 1986 and 2015, and [13] studies the mortality due to a cerebrovascular accident in kidney transplant recipients using the data in the Taiwan National Health Insurance Research Database (NHIRD) from 2000 to 2011. The Kaplan-Meier estimator [14] is a statistical technique that makes it possible to estimate subjects' survival function using as data only the time that they remain alive, and the function indicating censoring.…”