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Cerebrovascular Disease and Chronic Kidney Disease

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Abstract

Chronic kidney disease (CKD) is an independent risk factor for stroke. Patients with CKD are susceptible to ischemic as well as hemorrhagic stroke. The impairments in the small vessel vasculature, atherosclerotic changes of the large vessels, and coagulation abnormalities probably underlie the specific characteristics of stroke in CKD patients. The clinical outcomes, including functional outcomes and short- and long-term mortality after stroke, are poor in patients with CKD. CKD is defined as a decreased glomerular filtration rate (GFR) and/or increased urine albumin excretion. One or both of these markers were significantly associated with poor functional outcomes and mortality after stroke. Recent studies have suggested that proteinuria/albuminuria is more deeply involved in the clinical outcomes than GFR. The evidence for the most effective management of acute stroke in CKD patients is lacking, and thus, the current treatment for stroke is optimized for individual patients based on their background. In this chapter, the scope of the problem, types of cerebrovascular disease, transient ischemic attack (TIA), and ischemic and hemorrhagic stroke were defined with an emphasis regarding the role of an impaired kidney function on the features of the stroke. The management of stroke in CKD patients is also discussed, although no optimal treatment protocol has yet been established.

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References

  1. Adams Jr HP, Brott TG, Crowell RM, Furlan AJ, Gomez CR, Grotta J, Helgason CM, et al. Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Circulation. 1994;90(3):1588–601.

    Article  PubMed  Google Scholar 

  2. Hill MD, Hackinski V. Stroke treatment: time is brain. Lancet. 1998;352(Suppl 3):SIII10–4.

    Google Scholar 

  3. Hacke W, Kaste M, Olsen TS, Orgogozo JM, Bogousslavsky J. European stroke initiative: recommendations for stroke management. Organisation of stroke care. J Neurol. 2000;247:732–48.

    CAS  PubMed  Google Scholar 

  4. Seliger SL, Gillen DL, Longstreth Jr WT, Kes-tenbaum B, Stehman-Breen CO. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int. 2003;64:603–9.

    Article  PubMed  Google Scholar 

  5. Micozkadioglu H, Ozelsancak R, Giray S, Arlier Z. CKD is associated with recurrent ischemia but not with hemorrhagic transformation in acute ischemic stroke patients. Ren Fail. 2013;35(11):1512–8.

    Google Scholar 

  6. Muntner P, Judd SE, McClellan W, Meschia JF, Warnock DG, Howard VJ. Incidence of stroke symptoms among adults with chronic kidney disease: results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Nephrol Dial Transplant. 2012;27:166–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Holzmann MJ, Aastveit A, Hammar N, Jung-ner I, Walldius G, Holme I. Renal dysfunction increases the risk of ischemic and hemorrhagic stroke in the general population. Ann Med. 2012;44:607–15.

    Article  PubMed  Google Scholar 

  8. Shimizu Y, Maeda K, Imano H, Ohira T, Kitamura A, Kiyama M, Okada T, Ishikawa Y, Shimamoto T, Yamagishi K, Tanigawa T, Iso H. Chronic kidney disease and drinking status in relation to risks of stroke and its subtypes. The Circulatory Risk in Communities Study (CIRCS). Stroke. 2011;42:2531–7.

    Article  PubMed  Google Scholar 

  9. Bugnicourt JM, Chillon JM, Massy ZA, Canaple S, Lamy C, Deramond H, Godefroy O. High prevalence of intracranial artery calcification in stroke patients with CKD: a retro-spective study. Clin J Am Soc Nephrol. 2009;4:284–90.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Guerrero-Romero F, Rodriguez-Moran M. Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus. Stroke. 1999;30:1787–91.

    Article  CAS  PubMed  Google Scholar 

  11. Go AS, Fang MC, Udaltsova N, Chang Y, Pomernacki NK, Borowsky L, Singer DE. Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation. 2009;119:1363–9.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Rodriguez-Yanez M, Castellanos M, Blanco M, Millan M, Nombela F, Sobrino T, Liza-soain I, Leira R, Serena J, Davalos A, Castillo J. Micro- and macroalbuminuria predict hemorrhagic transformation in acute ischemic stroke. Neurology. 2006;67:1172–7.

    Article  CAS  PubMed  Google Scholar 

  13. Ovbiagele B, Liebeskind DS, Pineda S, Saver JL. Strong independent correlation of proteinuria with cerebral microbleeds in patients with stroke and transient ischemic attack. Arch Neurol. 2010;67:45–50.

    Article  PubMed  Google Scholar 

  14. Ovbiagele B, Pineda S, Saver JL. Renal dysfunction and discharge destination in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2011;20:145–9.

    Article  PubMed  Google Scholar 

  15. Agrawal V, Rai B, Fellows J, McCullough PA. In-hospital outcomes with thrombolytic therapy in patients with renal dysfunction presenting with acute ischaemic stroke. Nephrol Dial Transplant. 2010;25:1150–7.

    Article  PubMed  Google Scholar 

  16. Naganuma M, Koga M, Shiokawa Y, Nakaga-wara J, Furui E, Kimura K, Yamagami H, Okada Y, Hasegawa Y, Kario K, Okuda S, Nishiyama K, Minematsu K, Toyoda K. Reduced estimated glomerular filtration rate is associated with stroke outcome after intravenous rt-PA. The Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry. Cerebrovasc Dis. 2011;31:123–9.

    Article  PubMed  Google Scholar 

  17. Adams Jr HP, del Zoppo GJ, von Kummer R. Management of stroke. A practical guide for the prevention, evaluation and treatment of acute stroke. 2nd ed. Caddo: Professional Communications Inc.; 2002. ISBN 1-884735-517.

    Google Scholar 

  18. Adams Jr HP, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056–83.

    Google Scholar 

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Correspondence to Zülfikar Arlier MD .

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© 2014 Springer-Verlag Berlin Heidelberg

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Giray, S., Arlier, Z. (2014). Cerebrovascular Disease and Chronic Kidney Disease. In: Arici, M. (eds) Management of Chronic Kidney Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54637-2_14

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  • DOI: https://doi.org/10.1007/978-3-642-54637-2_14

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  • Publisher Name: Springer, Berlin, Heidelberg

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