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. 2012;7(4):e36332.
doi: 10.1371/journal.pone.0036332. Epub 2012 Apr 30.

Chronic kidney disease itself is a causal risk factor for stroke beyond traditional cardiovascular risk factors: a nationwide cohort study in Taiwan

Yi-Chun Chen  1 , Yu-Chieh Su, Ching-Chih Lee, Yung-Sung Huang, Shang-Jyh Hwang
Affiliations

Chronic kidney disease itself is a causal risk factor for stroke beyond traditional cardiovascular risk factors: a nationwide cohort study in Taiwan

Yi-Chun Chen et al. PLoS One. 2012.

Abstract

Background: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in patients with chronic kidney disease (CKD). In Taiwan, CVD is dominated by strokes but there is no robust evidence for a causal relationship between CKD and stroke. This study aimed to explore such causal association.

Methods: We conducted a nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database from 2004 to 2007. Each patient identified was individually tracked for a full three years from the index admission to identify those in whom any type of stroke developed. The study cohort consisted of patients hospitalized with a principal diagnosis of CKD and no traditional cardiovascular risk factors at baseline (n = 1393) and an age-matched control cohort of patients hospitalized for appendectomies (n = 1393, a surrogate for the general population). Cox proportional hazard regression and propensity score model were used to compare the three-year stroke-free survival rate of the two cohorts after adjustment for possible confounding factors.

Results: There were 256 stroke patients, 156 (11.2%) in the study cohort and 100 (7.2%) in the control cohort. After adjusting for covariates, patients with primary CKD had a 1.94-fold greater risk for stroke (95% CI, 1.45-2.60; p<0.001) based on Cox regression and a 1.68-fold greater risk for stroke (95% CI, 1.25-2.25; p = 0.001) based on propensity score. This was still the case for two cohorts younger than 75 years old and without traditional cardiovascular risk factors.

Conclusions: This study of Taiwanese patients indicates that CKD itself is a causal risk factor for stroke beyond the traditional cardiovascular risk factors. Primary CKD patients have higher risk for stroke than the general population and all CKD patients, irrespective of the presence or severity of traditional cardiovascular risk factors, should be made aware of the stroke risk and monitored for stroke prevention.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cumulative risk of stroke for the primary chronic kidney disease and appendectomy (control) groups in the 3-year follow-up.
See this image and copyright information in PMC

References

    1. Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, et al. United States Renal Data System 2010 Annual Data Report. Am J Kidney Dis. 2011;57(1 Suppl 1):A8,e1–526. - PubMed
    1. Nakayama M, Metoki H, Terawaki H, Ohkubo T, Kikuya M, et al. Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population–the Ohasama study. Nephrol Dial Transplant. 2007;22:1910–1915. - PubMed
    1. Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, et al. Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn study. Kidney Int. 2002;62:1402–1407. - PubMed
    1. Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, et al. Chronic kidney disease and cardiovascular disease in a general Japanese population: The Hisayama study. Kidney Int. 2005;68:228–236. - PubMed
    1. Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, et al. Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int. 1999;56:2214–2219. - PubMed