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Kidney Week

Abstract: PO2356

The Association of CKD Severity with Stroke Subtype Using the TOAST Classification

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Noor, Salmi Tahseen, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  • Bota, Sarah E., Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
  • Clarke, Anna E., Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
  • Kelly, Dearbhla, University of Oxford Nuffield Department of Clinical Neurosciences, Oxford, Oxfordshire, United Kingdom
  • Knoll, Greg A., University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  • Sood, Manish M., University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
Background

Ischemic stroke affects approximately 67.5 million people worldwide. The risk of acute ischemic stroke largely increases with advanced chronic kidney disease (CKD). However, whether the risk of specific ischemic stroke subtype varies with declining kidney function remains unclear. The purpose of this study was to assess the association between ischemic stroke subtypes (cardioembolic [CE], arterial, lacunar, other) classified using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and CKD stage.

Methods

This is a cross-sectional, retrospective cohort study of adults (≥18 years) with an ischemic stroke who presented to the emergency department in Ontario, Canada between April 1, 2002- March 31, 2013 and who had an inpatient serum creatinine measurement or were on chronic dialysis. All patients captured in the stroke registry with an estimated glomerular filtration rate (eGFR) were included and CKD severity was categorised as ≥60, 30-59, <30 mL/min/1.73m2 or chronic dialysis.

Results

A total of 17,434 individuals with an ischemic stroke were included (58.9% eGFR ≥60, 34.7% eGFR 30-59, 6.0% eGFR<30, 0.5% on chronic dialysis; mean age of 73 years; 48% female). Among patients with an eGFR 30-59 (50.4%) and < 30 (50.6%), CE stroke was more common compared to those with an eGFR >60 (36.8%) or on chronic dialysis patients (37.3%). The odds of CE stroke vs. non-CE stroke were eGFR 30-59 odds ratio (OR) 1.20 95% confidence interval (CI) 1.10-1.31, eGFR<30 OR 1.21 95% CI 1.02-1.44, dialysis OR 0.86 95% CI 0.48-1.57, eGFR>60 referent). We found lower adjusted odds of lacunar stroke in those with advanced CKD (lacunar vs. non-lacunar: eGFR 30-59 OR 0.85 95% CI 0.77-0.93, eGFR<30 OR 0.73 95% CI 0.61-0.88, dialysis OR 1.25 95% CI 0.68-2.28, eGFR>60 referent). In subgroup analyses (eGFR>=30 and <30), CE strokes were also more common in those >65 years, with atrial fibrillation, no anticoagulation or an INR <2.

Conclusion

Chronic kidney disease (eGFR<60, pre-dialysis CKD) is associated with a higher odds of CE stroke compared to patients with normal to high kidney function or those on chronic dialysis. Normal/mildly decreased eGFR were associated with the development of lacunar strokes. Detailed stroke subtyping in CKD may therefore provide mechanistic insights and refocus treatment strategies in this vulnerable group.