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Abstract: PO1796

Associations of CKD with Dementia Before and After Transient Ischemic Attack and Stroke in a Population-Based Cohort Study

Session Information

Category: Hypertension and CVD

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

Authors

  • Kelly, Dearbhla, University of Oxford Nuffield Department of Clinical Neurosciences, Oxford, Oxfordshire, United Kingdom
  • Rothwell, Peter M., University of Oxford Nuffield Department of Clinical Neurosciences, Oxford, Oxfordshire, United Kingdom

Group or Team Name

  • The Oxford Vascular Study
Background

Individuals with chronic kidney disease (CKD) appear to have a greater risk of developing cognitive disorders than the general population. Both vascular and neurodegenerative hypotheses have been proposed to underlie this cognitive burden. To explore the vascular hypothesis further, we investigated the association between CKD and dementia before and after transient ischaemic attack (TIA) and stroke.

Methods

In a prospective, population-based cohort study of TIA and stroke (Oxford Vascular Study; 2002-2012), pre-event and new post-event dementia were ascertained through direct patient assessment and follow-up for 5 years, supplemented by review of hospital/primary care records. Associations between pre-dementia and CKD (defined as an estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m2) were examined using logistic regression, and between post-event dementia and CKD using both Cox and competing risk regression models, adjusted for age, sex, education, cerebrovascular burden (stroke severity, prior stroke, white matter disease), diabetes mellitus, and dysphasia.

Results

Among 2305 TIA/stroke patients (median [IQR] age, 77 [67-84] years, 1174 [51%] male, 688 [30%] TIA), 1174 (50.9%) had CKD. CKD initially appeared to be associated with both pre-event (odds ratio [OR], 2.04 [95% CI, 1.52–2.72]; P<0.001) and post-event dementia (hazard ratio [HR], 2.01 [95% CI, 1.65–2.44]; P<0.001); however, these associations attenuated and became non-significant after adjustment for the above covariates (OR=0.92 [0.65-1.31]; p=0.65 and HR=1.09 [0.85-1.39]; p=0.50). The results were similar when a competing risk model was used (subdistribution HR [SHR] =1.74 [1.43-2.12; p<0.001, attenuating to 1.01 [0.78-1.33]; p=0.92 with complete adjustment). CKD was more strongly associated with late (>1 year) post-event dementia (SHR=2.32, 1.70-3.17; p<0.001), particularly in the minor events subgroup (SHR=3.08, 2.05-4.64; p<0.001), but not significantly so after complete adjustment (SHR=1.53, 0.90-2.60; p=0.12).

Conclusion

In patients with TIA and stroke, CKD was not independently associated with either pre- or post-event dementia, suggesting that age, sex, education, and cerebrovascular burden may play a more important role in the relationship than renal-specific neurodegenerative mechanisms.