Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Sep 4;79(10):981-7.
doi: 10.1212/WNL.0b013e31826845e9. Epub 2012 Aug 8.

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

Manjula Kurella Tamura  1 , Jaclyn Biada Meyer, Anjali B Saxena, J W Terri Huh, Virginia G Wadley, Brigitte Schiller
Affiliations

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

Manjula Kurella Tamura et al. Neurology. .

Abstract

Objective: The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA.

Methods: We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.

Results: Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p ≤ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03-5.92) and IADL impairment (OR 3.86, 95% CI 1.60-9.28).

Conclusions: Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Prevalence and type of stroke symptoms among dialysis participants without a history of stroke or TIA
Figure 2
Figure 2. Association of stroke symptoms with cognitive impairment and instrumental activities of daily living (IADL) impairment among dialysis participants
The multivariable models are adjusted for age, sex, race, education, language, diabetes, and cardiovascular disease. Cognitive impairment adjusted model c = 0.75. IADL impairment adjusted model c = 0.69.
See this image and copyright information in PMC

Comment in

References

    1. Seliger SL, Gillen DL, Longstreth WT, Jr, Kestenbaum B, Stehman-Breen CO. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int 2003; 64: 603– 609 . - PubMed
    1. Sozio SM, Armstrong PA, Coresh J, et al. Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. Am J Kidney Dis 2009; 54: 468– 477 . - PMC - PubMed
    1. Nakatani T, Naganuma T, Uchida J, et al. Silent cerebral infarction in hemodialysis patients. Am J Nephrol 2003; 23: 86– 90 . - PubMed
    1. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003; 348: 1215– 1222 . - PubMed
    1. Wadley VG, McClure LA, Howard VJ, et al. Cognitive status, stroke symptom reports, and modifiable risk factors among individuals with no diagnosis of stroke or transient ischemic attack in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke 2007; 38: 1143– 1147 . - PubMed

Publication types

MeSH terms