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Abstract: PO2107

CKD Predicts Stroke Severity, Disability, and Early Recurrence in a Population-Based Cohort Study

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

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 associated with cerebrovascular disease and related mortality, and with under-utilisation of acute and preventive treatments, but any impact on initial event severity and recurrence risk is unclear. We aimed to determine whether CKD is associated with worse initial stroke severity and disability, and whether CKD is independently predictive of recurrent stroke and other vascular events.

Methods

In a population-based study of all TIA/stroke (Oxford Vascular Study), we studied initial stroke severity and disability using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS), respectively, in relation to CKD in all patients presenting with TIA and stroke from April 1, 2002 to March 31, 2017. Associations between CKD and event severity, and between CKD and risk of recurrent vascular events (stroke, myocardial infarction, and sudden cardiac death) were examined using ordinal and Cox regression models, respectively, adjusted for age, sex, and known vascular risk factors, and stratified by TOAST subtype.

Results

Among 3178 patients with TIA (n=1167), ischaemic stroke (n=1802), and intracerebral haemorrhage (n=209), 1267 (40%) had CKD. CKD was independently associated with greater risk of ischaemic stroke compared to TIA (adjusted OR=1.31, 95%CI=1.11-1.56; p=0.002) and with greater initial NIHSS (adjusted OR=1.28, 1.04-1.46; p=0.018), driven mostly by those with an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m2 (adjusted OR=2.59, 1.44-4.66; p=0.001 for ischaemic stroke; adjusted OR=4.06, 2.04-8.06; p<0.001 for initial NIHSS). Among patients with ischaemic stroke, CKD was also associated with higher one-month mRS scores (adjusted OR=1.40, 1.13-1.74; p=0.002), driven by those with an eGFR < 30 ml/min/1.73m2 (Adjusted OR=6.51, 3.04-13.97, p<0.001). Risk of early (< 90 days) recurrent stroke was increased with CKD (adjusted HR=1.60, 1.15-2.21; p=0.005) as was the risk of longer-term (0-15 years) composite vascular outcomes (adjusted HR=1.14, 1.05-1.46; p=0.01).

Conclusion

The consistent independent impact of CKD on initial event severity, early disability and recurrence risk suggests that there may be processes intrinsic to CKD leading to uniformly worse outcomes. Further research should determine whether there are CKD-specific treatments that may improve stroke outcomes.