Abstract: SA-PO881
The Impact of Prevalent Stroke at Critical Junctures in the Care for Patients with Kidney Disease
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Tollitt, James, Salford Royal NHS Trust, Salford, United Kingdom
- Odudu, Aghogho, University of Manchester, Manchester, United Kingdom
- Chinnadurai, Rajkumar, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
- Flanagan, Emma, Salford Care Organisation, Salford, United Kingdom
- Smith, Craig J., University of Manchester, Manchester, United Kingdom
- Kalra, Philip A., Salford Royal Hospital NHS Trust, Salford, United Kingdom
Background
Chronic kidney disease is an independent risk factor for stroke in the general population. The impact of a prior stroke on important outcomes for CKD patients is less well characterised. We examined associations between prior stroke and clinical outcomes in a large UK CKD cohort at study recruitment and at time of dialysis commencement
Methods
3060 participants of the Salford Kidney Study (a large UK CKD longitudinal epidemiological cohort study recruiting since October 2002) were included in the analysis. Multivariable cox regression survival analyses, adjusted for competing risks, was performed to examine the effects of prevalent stroke on endpoints of death, end stage renal disease (ESRD) and non-fatal cardiovascular events (NFCVE).
Similar methodology was used to examine the impact of prior stroke on survival in patients who commenced dialysis
Results
Of 3060 study recruits 227 had suffered a stroke prior to recruitment (table 1). Stroke was independently associated with mortality (HR 1.20 95%CI 1.0-1.43, p=0.05), reaching ESRD (HR 1.34 95%CI 1.06-1.69, p=0.02) and future NFCVE (HR 1.54 95%CI 1.12-2.11, p=0.01) after adjustment for age, gender, eGFR, diabetes, hypertension, myocardial infarction, heart failure, atrial fibrillation, smoking history and peripheral vascular disease. 579 patients reached ESRD and commenced dialysis. Stroke prior to dialysis commencement (N=48) was significantly associated with mortality (HR 1.47 (95%CI 1.01-2.14 P=0.05) after adjustment for the same factors (except eGFR) over median 25 months follow up.
Conclusion
Sroke prior to study recruitment was independently associated with mortality, ESRD and future NFCVE. Similarly, stroke was independently associated with mortality in patients who commenced dialysis. This large observational study indicates that stroke alters cardiovascular risk in CKD patients and emphasises the importance of kidney brain crosstalk.
Comparison between patient outcomes (Prevalent stroke v no prevalent stroke)
| Outcome | No Stroke at Recruitment N=2833 | Stroke at Rectuitment N=227 | |
| Stroke | 81 (2.9%) | 20 (8.8%) | <0.001 |
| Myocardial Infarction | 154 (5.4%) | 24 (10.6%) | 0.001 |
| End Stage Renal Disease | 887 (31.3%) | 92 (40.5%) | 0.004 |
| All cause mortality | 1275 (45%) | 157 (69.2%) | <0.000 |
| Death from cardiovascular disease | 174 (43.5%) | 31 (57.5%) | <0.001 |
Between group comparisons made using chi square test