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Kidney Week

Abstract: PO2153

Aetiological Subtypes of Transient Ischemic Attack and Ischaemic Stroke in CKD: A Population-Based Study

Session Information

Category: Hypertension and CVD

  • 1403 Hypertension and CVD: Mechanisms

Authors

  • Kelly, Dearbhla, Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
  • Rothwell, Peter M., Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom

Group or Team Name

  • Oxford Vascular Study
Background

Chronic kidney disease (CKD) is strongly associated with stroke risk but the mechanisms underlying this association are unclear, and might be informed by subtype-specific analyses. However, few studies have reported stroke subtypes in CKD according to established classification systems such as the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. We therefore aimed to determine which transient ischaemic attack (TIA) and ischaemic stroke subtypes using the TOAST classification occur most frequently in patients with CKD.


Methods

In a population-based study of all TIA and stroke (Oxford Vascular Study; 2002-2017), all ischaemic events were classified by TOAST subtypes (cardioembolism, large artery disease, small vessel disease, undetermined, multiple, other aetiology, or incompletely investigated). Logistic regression was used to determine the relationship between CKD (defined as an estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m2) and TIA/stroke subtypes adjusted for age, sex, and hypertension, and then stratified by age and eGFR category.

Results

Among 3178 patients with TIA (n=1167), ischaemic stroke (n=1802), and intracerebral haemorrhage (n=209), 1267 (40%) had CKD. Although there was a greater prevalence of cardioembolic events (31.8 vs 21.2%; p<0.001) in patients with CKD, this association was lost after adjustment for age, sex, and hypertension (Adjusted OR=1.20, 95% CI=0.99-1.45; p=0.07). Similarly, although patients with CKD had a lower prevalence of small vessel disease (8.8 vs 13.6%; p<0.001), undetermined (26.1 vs 39.4%; p<0.001), and other aetiology (1.0 vs 3.6%; p<0.001) subtypes, these associations were also lost after adjustment (Adjusted OR=0.86, 0.65-1.13; p=0.27 and 0.73, 0.36-1.43; p=0.37 for small vessel disease and other defined aetiology, respectively) for all but undetermined aetiology (Adjusted OR=0.81, 0.67-0.98; p=0.03).

Conclusion

There were no independent positive associations between CKD and specific TOAST subtypes which suggests that renal-specific risk factors are unlikely to play an important role in the aetiology of particular subtypes. Future studies of stroke and CKD should report subtype-specific analyses to gain further insights into potential mechanisms.