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Girach Z, Sarian A, Maldonado-García C, Ravikumar N, Sergouniotis PI, Rothwell PM, Frangi AF, Julian TH. Retinal imaging for the assessment of stroke risk: a systematic review. J Neurol 2024; 271:2285-2297. [PMID: 38430271 PMCID: PMC11055692 DOI: 10.1007/s00415-023-12171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a technology which is garnering increasing attention as a means of assessing cardiovascular health and stroke risk. METHODS A biomedical literature search was performed to identify prospective studies that assess the role of retinal imaging derived biomarkers as indicators of stroke risk. RESULTS Twenty-four studies were included in this systematic review. The available evidence suggests that wider retinal venules, lower fractal dimension, increased arteriolar tortuosity, presence of retinopathy, and presence of retinal emboli are associated with increased likelihood of stroke. There is weaker evidence to suggest that narrower arterioles and the presence of individual retinopathy traits such as microaneurysms and arteriovenous nicking indicate increased stroke risk. Our review identified three models utilizing artificial intelligence algorithms for the analysis of retinal images to predict stroke. Two of these focused on fundus photographs, whilst one also utilized optical coherence tomography (OCT) technology images. The constructed models performed similarly to conventional risk scores but did not significantly exceed their performance. Only two studies identified in this review used OCT imaging, despite the higher dimensionality of this data. CONCLUSION Whilst there is strong evidence that retinal imaging features can be used to indicate stroke risk, there is currently no predictive model which significantly outperforms conventional risk scores. To develop clinically useful tools, future research should focus on utilization of deep learning algorithms, validation in external cohorts, and analysis of OCT images.
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Affiliation(s)
- Zain Girach
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Broomhall, Sheffield, UK
| | - Arni Sarian
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Cynthia Maldonado-García
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Panagiotis I Sergouniotis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Alejandro F Frangi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- School of Computer Science, Faculty of Science and Engineering, University of Manchester, Kilburn Building, Manchester, UK
- Christabel Pankhurst Institute, The University of Manchester, Manchester, UK
| | - Thomas H Julian
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK.
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK.
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Wyld M, Webster AC. Myocardial infarction and stroke in patients with kidney failure: can we do better? Eur Heart J 2024; 45:1352-1354. [PMID: 38537266 DOI: 10.1093/eurheartj/ehae153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Affiliation(s)
- Melanie Wyld
- Faculty of Medicine and Health, University of Sydney, Sydney School of Public Health, 129a Edward Ford Building A27, Sydney, NSW 2006Australia
- Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Angela C Webster
- Faculty of Medicine and Health, University of Sydney, Sydney School of Public Health, 129a Edward Ford Building A27, Sydney, NSW 2006Australia
- Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, NSW, Australia
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Pavuluri KS, Pathi D, Dash SK, Das P, Panda SS. Microalbuminuria as a Predictor of Early Neurological Deterioration and Poor Functional Outcomes in Acute Ischemic Stroke. Cureus 2024; 16:e58311. [PMID: 38752035 PMCID: PMC11095285 DOI: 10.7759/cureus.58311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Background Ischemic stroke is a major health crisis with significant consequences. Microalbuminuria, a sign of endothelial dysfunction, has been linked to adverse outcomes in ischemic stroke. Early neurological deterioration (END) is a critical factor influencing the patient's prognosis. This study aimed to determine the prevalence of microalbuminuria, its predictive value in assessing END, and its prognostic implications in acute ischemic stroke (AIS). Methodology This study conducted at Pradyumna Bal Memorial Hospital, Kalinga Institute of Medical Sciences Bhubaneswar (November 2020-April 2022) included 114 AIS patients over 18 years who presented within 24 hours of stroke onset. Demographics, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) scores (admission and day three), modified Rankin scores (day 10), urinary albumin-to-creatinine ratios, and carotid artery Doppler studies were collected. Results The mean age of the patients was 61.87 years, with males constituting 72.8% of the population. Hypertension (50.9%) and diabetes mellitus (28.9%) were the most common comorbid conditions. The mean NIHSS stroke severity at presentation was 11.30. END occurred in 38.6% of patients. Overall, 43.9% of cases showed carotid stenosis, and the mean carotid intimal media thickness was 1.08 mm. Notably, the presence of microalbuminuria significantly increased the chances of both END (39.45 times higher risk) and worse functional outcomes (odds ratio = 19.147, p = 0.001). Conclusions Microalbuminuria emerges as a robust independent predictor of END and a poor prognosis in AIS. These findings highlight the importance of early microalbuminuria identification and intervention to reduce END risk and potentially improve outcomes in AIS patients.
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Affiliation(s)
| | - Debasis Pathi
- General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Pragateshnu Das
- Neurology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Ha JT, Freedman SB, Kelly DM, Neuen BL, Perkovic V, Jun M, Badve SV. Kidney Function, Albuminuria, and Risk of Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis. Am J Kidney Dis 2024; 83:350-359.e1. [PMID: 37777059 DOI: 10.1053/j.ajkd.2023.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 10/02/2023]
Abstract
RATIONALE & OBJECTIVE Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist. However, it is not known whether CKD is an independent risk factor for incident AF. Therefore, we evaluated the association between markers of CKD-estimated glomerular filtration rate (eGFR) and albuminuria-and incident AF. STUDY DESIGN Systematic review and meta-analysis of cohort studies and randomized controlled trials. SETTING & STUDY POPULATIONS Participants with measurement of eGFR and/or albuminuria who were not receiving dialysis. SELECTION CRITERIA FOR STUDIES Cohort studies and randomized controlled trials were included that reported incident AF risk in adults according to eGFR and/or albuminuria. ANALYTICAL APPROACH Age- or multivariate-adjusted risk ratios (RRs) for incident AF were extracted from cohort studies, and RRs for each trial were derived from event data. RRs for incident AF were pooled using random-effects models. RESULTS 38 studies involving 28,470,249 participants with 530,041 incident AF cases were included. Adjusted risk of incident AF was greater among participants with lower eGFR than those with higher eGFR (eGFR<60 vs≥60mL/min/1.73m2: RR, 1.43; 95% CI, 1.30-1.57; and eGFR<90 vs≥90mL/min/1.73m2: RR, 1.42; 95% CI, 1.26-1.60). Adjusted incident AF risk was greater among participants with albuminuria (any albuminuria vs no albuminuria: RR, 1.43; 95% CI, 1.25-1.63; and moderately to severely increased albuminuria vs normal to mildly increased albuminuria: RR, 1.64; 95% CI, 1.31-2.06). Subgroup analyses showed an exposure-dependent association between CKD and incident AF, with the risk increasing progressively at lower eGFR and higher albuminuria categories. LIMITATIONS Lack of patient-level data, interaction between eGFR and albuminuria could not be evaluated, possible ascertainment bias due to variation in the methods of AF detection. CONCLUSIONS Lower eGFR and greater albuminuria were independently associated with increased risk of incident AF. CKD should be regarded as an independent risk factor for incident AF. PLAIN-LANGUAGE SUMMARY Irregular heartbeat, or atrial fibrillation (AF), is the commonest abnormal heart rhythm. AF occurs commonly in people with chronic kidney disease (CKD), and CKD is also common in people with AF. However, CKD in not widely recognized as a risk factor for new-onset or incident AF. In this research, we combined data on more than 28 million participants in 38 studies to determine whether CKD itself increases the chances of incident AF. We found that both commonly used markers of kidney disease (estimated glomerular filtration rate and albuminuria, ie, protein in the urine) were independently associated with a greater risk of incident AF. This finding suggests that CKD should be recognized as an independent risk factor for incident AF.
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Affiliation(s)
- Jeffrey T Ha
- The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia
| | - S Ben Freedman
- Heart Research Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Dearbhla M Kelly
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Brendon L Neuen
- The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Min Jun
- The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Sunil V Badve
- The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia.
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Niu J, Chen K, Wu J, Ma L, Zhao G, Ding Y. Thrombectomy versus combined thrombolysis and thrombectomy in patients with large vessel occlusion and chronic kidney disease. Heliyon 2024; 10:e26110. [PMID: 38404773 PMCID: PMC10884842 DOI: 10.1016/j.heliyon.2024.e26110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
Background Whether intravenous thrombolysis (IVT) should be bridged before mechanical thrombectomy (MT) remains uncertain in patients with large vessel occlusion (LVO) and chronic kidney disease (CKD). Methods This research systematically enrolled every patient with both acute ischemic stroke (AIS) and CKD who received MT and fulfilled the criteria for IVT from January 2015 to December 2022. According to whether they underwent IVT, the patients were categorized into two cohorts: MT and combined IVT + MT. A binary logistic regression model was used to adjust for potential confounders, and propensity score matching analysis was used to assess the efficacy and safety of IVT in AIS patients with CKD who underwent MT. Results A total number of 406 patients were ultimately included in this study, with 236 patients in the MT group and 170 in the combined group. After PSM, there were 170 patients in the MT group and 170 in the combined group, and the clinical characteristics between the two groups were well balanced. The MT + IVT group had better long-term functional outcomes than the MT group (35.9% versus 21.2%, P = 0.003) and more modified thrombolysis in cerebral infarction (mTICI) (2b-3) (94.1% versus 87.6%, P = 0.038), while no significant difference was found regarding symptomatic intracranial hemorrhage (sICH). In line with the results observed in the in the postmatched population, the logistic regression revealed that patients in the IVT + MT group demonstrated superior clinical outcomes (adjusted OR 0.440 [95% CI (0.267-0.726)], P = 0.001) in the prematched population. Conclusion For LVO patients with CKD and indications for IVT, IVT bridging MT improves their prognosis compared with direct MT.
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Affiliation(s)
- Jiali Niu
- Department of Clinical Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China
| | - Kaixia Chen
- Department of Pharmacy, JingJiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China
| | - Jian Wu
- Hospital office, JingJiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China
| | - Li Ma
- Department of Neurology, Shaoxing Second Hospital, the Second Affiliated Hospital of Shaoxing University, Zhejiang, China
| | - Guangyu Zhao
- Department of Clinical Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China
| | - Yunlong Ding
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease. J Am Heart Assoc 2024; 13:e030131. [PMID: 38214258 PMCID: PMC10926810 DOI: 10.1161/jaha.123.030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Albuminuria, an established biomarker of the progression of chronic kidney disease, is also recognized as a biomarker for the risk of cardiovascular disease. Elevated urinary albumin excretion indicates kidney damage and systemic vascular disease, including myocardial capillary disease and arterial stiffness. Albuminuria is associated with an increased risk of coronary artery disease, stroke, heart failure, arrhythmias, and microvascular disease. There are now several therapeutic agents that can lead to albuminuria lowering and a reduction in cardiovascular risk. However, screening for albuminuria is still low. Considering the importance of multidisciplinary management of patients with cardiovascular disease, it is crucial that health care professionals managing such patients are aware of the benefits of albuminuria surveillance and management.
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Chang Y, Kang MK, Park MS, Leem GH, Song TJ. Resolved Proteinuria May Attenuate the Risk of Heart Failure: A Nationwide Population-Based Cohort Study. J Pers Med 2023; 13:1662. [PMID: 38138889 PMCID: PMC10744716 DOI: 10.3390/jpm13121662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
Although proteinuria is a risk factor for heart failure (HF), proteinuria can be reversible or persistent. Our objective was to explore the link between changes in the proteinuria status and the risk of HF. We included participants from a Korean national health screening cohort who underwent health examinations in 2003-2004 and 2005-2006 and had no history of HF. Participants were categorized into four groups: proteinuria-free, proteinuria-resolved, proteinuria-developed, and proteinuria-persistent. The outcome of interest was the occurrence of HF. The study included 1,703,651 participants, among whom 17,543 (1.03%) were in the proteinuria-resolved group and 4585 (0.27%) were in the proteinuria-persistent group. After a median follow-up period of 14.04 years (interquartile range 14.19-15.07), HF occurred in 75,064 (4.41%) participants. A multivariable Cox proportional hazards regression analysis indicated that the proteinuria-persistent group had a higher risk of HF compared with the proteinuria-free group (hazard ratio (HR): 2.19, 95% confidence interval (CI): 2.03-2.36, p < 0.001). In a further pairwise comparison analysis, participants in the proteinuria-resolved group had a relatively low risk of HF compared with those in the proteinuria-persistent group (HR: 0.64, 95% CI: 0.58-0.70, p < 0.001). In conclusion, the risk of HF can change with alterations in the proteinuria status.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul 08209, Republic of Korea;
| | - Min Kyoung Kang
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (M.K.K.); (M.-S.P.)
| | - Moo-Seok Park
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (M.K.K.); (M.-S.P.)
| | - Gwang-Hyun Leem
- Ewha Medical Research Institute, Ewha Womans University, Seoul 07804, Republic of Korea;
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (M.K.K.); (M.-S.P.)
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Kelly DM, Georgakis MK, Franceschini N, Blacker D, Viswanathan A, Anderson CD. Interplay Between Chronic Kidney Disease, Hypertension, and Stroke: Insights From a Multivariable Mendelian Randomization Analysis. Neurology 2023; 101:e1960-e1969. [PMID: 37775316 PMCID: PMC10662984 DOI: 10.1212/wnl.0000000000207852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) increases the risk of stroke, but the extent through which this association is mediated by hypertension is unknown. We leveraged large-scale genetic data to explore causal relationships between CKD, hypertension, and cerebrovascular disease phenotypes. METHODS We used data from genome-wide association studies of European ancestry to identify genetic proxies for kidney function (CKD diagnosis, estimated glomerular filtration rate [eGFR], and urinary albumin-to-creatinine ratio [UACR]), systolic blood pressure (SBP), and cerebrovascular disease (ischemic stroke and its subtypes and intracerebral hemorrhage). We then conducted univariable, multivariable, and mediation Mendelian randomization (MR) analyses to investigate the effect of kidney function on stroke risk and the proportion of this effect mediated through hypertension. RESULTS Univariable MR revealed associations between genetically determined lower eGFR and risk of all stroke (odds ratio [OR] per 1-log decrement in eGFR, 1.77; 95% CI 1.31-2.40; p < 0.001), ischemic stroke (OR 1.81; 95% CI 1.31-2.51; p < 0.001), and most strongly with large artery stroke (LAS) (OR 3.00; 95% CI 1.33-6.75; p = 0.008). These associations remained significant in the multivariable MR analysis, controlling for SBP (OR 1.98; 95% CI 1.39-2.82; p < 0.001 for all stroke; OR 2.16; 95% CI 1.48-3.17; p < 0.001 for ischemic stroke; OR 4.35; 95% CI 1.84-10.27; p = 0.001 for LAS), with only a small proportion of the total effects mediated by SBP (6.5% [0.7%-16.8%], 6.6% [0.8%-18.3%], and 7.2% [0.5%-24.8%], respectively). Total, direct and indirect effect estimates were similar across a number of sensitivity analyses (weighted median, MR-Egger regression). DISCUSSION Our results demonstrate an independent causal effect of impaired kidney function, as assessed by decreased eGFR, on stroke risk, particularly LAS, even when controlled for SBP. Targeted prevention of kidney disease could lower atherosclerotic stroke risk independent of hypertension.
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Affiliation(s)
- Dearbhla M Kelly
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.
| | - Marios K Georgakis
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Nora Franceschini
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Deborah Blacker
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Anand Viswanathan
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
| | - Christopher D Anderson
- From the J. Philip Kistler Stroke Research Center (D.M.K., A.V.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Program in Medical and Population Genetics (D.M.K., M.K.G., C.D.A.), Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston; Institute for Stroke and Dementia Research (M.K.G.), University Hospital of LMU Munich, Germany; McCance Center for Brain Health (M.K.G., C.D.A.), Massachusetts General Hospital, Boston; Department of Epidemiology (N.F.), University of North Carolina, Chapel Hill; Department of Psychiatry (D.B.), Massachusetts General Hospital, Harvard Medical School; Department of Epidemiology (D.B.), Harvard T.H. Chan School of Public Health; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA
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Kourtidou C, Tziomalos K. Epidemiology and Risk Factors for Stroke in Chronic Kidney Disease: A Narrative Review. Biomedicines 2023; 11:2398. [PMID: 37760839 PMCID: PMC10525494 DOI: 10.3390/biomedicines11092398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have a higher risk ofboth ischemic and hemorrhagic stroke. This association appears to be partly independent from the higher prevalence of established risk factors for stroke in patients with CKD, including hypertension and atrial fibrillation. In the present review we aim to discuss the impact of CKD on the risk of stroke and stroke-related consequences, and explore the pathophysiology underpinning the increased risk of stroke in patients with CKD. We cover the clinical association between renal dysfunction and cerebrovascular disease including stroke, silent brain infarct, cerebral small vessel disease, microbleeds, and white matter hyperintensity, and discuss the underlying mechanisms.
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Affiliation(s)
- Christodoula Kourtidou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
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Kurvits S, Harro A, Reigo A, Ott A, Laur S, Särg D, Tampuu A, Alasoo K, Vilo J, Milani L, Haller T. Common clinical blood and urine biomarkers for ischemic stroke: an Estonian Electronic Health Records database study. Eur J Med Res 2023; 28:133. [PMID: 36966315 PMCID: PMC10039346 DOI: 10.1186/s40001-023-01087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 03/04/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Ischemic stroke (IS) is a major health risk without generally usable effective measures of primary prevention. Early warning signals that are easy to detect and widely available can save lives. Estonia has one nation-wide Electronic Health Record (EHR) database for the storage of medical information of patients from hospitals and primary care providers. METHODS We extracted structured and unstructured data from the EHRs of participants of the Estonian Biobank (EstBB) and evaluated different formats of input data to understand how this continuously growing dataset should be prepared for best prediction. The utility of the EHR database for finding blood- and urine-based biomarkers for IS was demonstrated by applying different analytical and machine learning (ML) methods. RESULTS Several early trends in common clinical laboratory parameter changes (set of red blood indices, lymphocyte/neutrophil ratio, etc.) were established for IS prediction. The developed ML models predicted the future occurrence of IS with very high accuracy and Random Forests was proved as the most applicable method to EHR data. CONCLUSIONS We conclude that the EHR database and the risk factors uncovered are valuable resources in screening the population for risk of IS as well as constructing disease risk scores and refining prediction models for IS by ML.
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Affiliation(s)
- Siim Kurvits
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ainika Harro
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anu Reigo
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anne Ott
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Sven Laur
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Dage Särg
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Ardi Tampuu
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | | | - Kaur Alasoo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Software Technology and Applications Competence Center, Tartu, Estonia
| | - Lili Milani
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Toomas Haller
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1169] [Impact Index Per Article: 1169.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Park SK, Jung JY, Kim MH, Oh CM, Ha E, Shin SS, Lee HC, Hwang WY, Ryoo JH. The association between changes in proteinuria and the risk of cerebral infarction in the Korean population. Diabetes Res Clin Pract 2022; 192:110090. [PMID: 36122864 DOI: 10.1016/j.diabres.2022.110090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Proteinuria is a risk factor for cerebral infarction. It is known that proteinuria can change over time. However, published data is scarce for the association between changes in proteinuria and the risk of cerebral infarction. METHOD Study participants were 276,861 Koreans who were assessed for urine dipstick proteinuria both in 2003-2004 and 2007-2008. They were categorized into four groups by changes in proteinuria over 4 years (negative: negative → negative, resolved: proteinuria ≥ 1+ → negative, incident: negative → proteinuria ≥ 1+, persistent: proteinuria ≥ 1+ → proteinuria ≥ 1 + ). We used multivariate adjusted Cox-proportional hazard model in calculating the adjusted hazard ratios (HR) and 95% confidence interval (CI) for cerebral infarction until 2013 according to changes in proteinuria. RESULT Adjusted HR and 95% CI for cerebral infarction significantly increased in order of persistent, incident, and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.166 [1.009-1.347], incident: 1.345 [1.188-1.522], and persistent: 1.443 [1.089-1.912]). In gender subgroup analysis, men showed the more clear association between changes in proteinuria and the risk of cerebral infarction (negative: reference, resolved: 1.284 [1.057-1.560], incident: 1.351 [1.149-1.589], and persistent: 1.428 [1.014-2.012]). CONCLUSION All types of proteinuria changes were associated with the increased risk of cerebral infarction, even in participants with once manifested but vanishing proteinuria.
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Affiliation(s)
- Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Min-Ho Kim
- Department of Preventive Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea; Informatization Department, Ewha Womans University Seoul Hospital, Seoul, Korea..
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Soon Su Shin
- Department of Occupational & Environmental Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Hyo Choon Lee
- Department of Occupational & Environmental Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Woo Yeon Hwang
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Fujiwara W, Ishii H, Sobue Y, Shimizu S, Ishiguro T, Yamada R, Ueda S, Nishimura H, Niwa Y, Miyazaki A, Miyagi W, Takahara S, Naruse H, Ishii J, Kiyono K, Watanabe E, Izawa H. A simple proteinuria-based risk score predicts contrast-associated acute kidney injury after percutaneous coronary intervention. Sci Rep 2022; 12:12331. [PMID: 35853998 PMCID: PMC9296582 DOI: 10.1038/s41598-022-16690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a complication of percutaneous coronary intervention (PCI). Because proteinuria is a sentinel marker of renal dysfunction, we assessed its role in predicting CA-AKI in patients undergoing PCI. A total of 1,254 patients undergoing PCI were randomly assigned to a derivation (n = 840) and validation (n = 414) dataset. We identified the independent predictors of CA-AKI where CA-AKI was defined by the new criteria issued in 2020, by a multivariate logistic regression in the derivation dataset. We created a risk score from the remaining predictors. The discrimination and calibration of the risk score in the validation dataset were assessed by the area under the receiver-operating characteristic curves (AUC) and Hosmer–Lemeshow test, respectively. A total of 64 (5.1%) patients developed CA-AKI. The 3 variables of the risk score were emergency procedures, serum creatinine, and proteinuria, which were assigned 1 point each based on the correlation coefficient. The risk score demonstrated a good discriminative power (AUC 0.789, 95% CI 0.766–0.912) and significant calibration. It was strongly associated with the onset of CA-AKI (Cochran-Armitage test, p < 0.0001). Our risk score that included proteinuria was simple to obtain and calculate, and may be useful in assessing the CA-AKI risk before PCI.
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Affiliation(s)
- Wakaya Fujiwara
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan.
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yoshihiro Sobue
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Shinya Shimizu
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Tomoya Ishiguro
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Ryo Yamada
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Sayano Ueda
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Hideto Nishimura
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Yudai Niwa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akane Miyazaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Wataru Miyagi
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Shuhei Takahara
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junichi Ishii
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Ken Kiyono
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University, Suita, Japan
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, 454-8509, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
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Correlation between microalbuminuria and atherosclerotic intracranial and extracranial arterial stenosis in patients with cerebral infarction. J Clin Neurosci 2022; 101:118-123. [PMID: 35594832 DOI: 10.1016/j.jocn.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Microalbuminuria (MAU) reflects the generalized vascular endothelial dysfunction. Whether MAU has correlation with atherosclerotic intracranial and extracranial arterial stenosis in cerebral infarction patients is not known and is explored in the present investigation. METHODS We enrolled 255 cerebral infarction patients hospitalized at the department of neurology. All patients underwent digital subtraction angiography (DSA) to evaluate the severity and distribution of intracranial and extracranial arterial stenosis. MAU was expressed as the urine albumin-to-creatinine ratio (UACR). We collected basic information, medical history reviews and laboratory results of each participant. The multivariate logistic regression analysis was utilized to analyze the risk factors for severity and distribution of cerebral arterial stenosis. RESULTS The prevalence of MAU in patients with cerebral infarction was 39.2%, patients with MAU had older age, lower blood uric acid, higher systolic blood pressure (SBP), higher prevalence of hypertension and diabetes (p < 0.05) and higher incidence of atherosclerotic intracranial and extracranial arterial stenosis (χ2 = 5.900, p = 0.015). In multiple logistic regression analysis for intracranial and extracranial arterial stenosis more than 50% or occlusion groups, UACR (OR 1.088 95%CI 1.012-1.170p = 0.022), male (OR 2.196 95%CI 1.085-4.442p = 0.029) as well as SBP (OR 5.870 95%CI 1.026-1.048p = 0.015) showed statistical significance. But UACR had no correlation with the distribution of intracranial and extracranial artery stenosis after adjusting for all potential confounders. CONCLUSIONS Microalbuminuria was an independent risk factor for intracranial and extracranial arterial stenosis more than 50% or occlusion.
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Wakasugi M, Yokoseki A, Wada M, Sanpei K, Momotsu T, Sato K, Kawashima H, Nakamura K, Onodera O, Narita I. Stroke incidence and chronic kidney disease: a hospital-based prospective cohort study. Nephrology (Carlton) 2022; 27:577-587. [PMID: 35488413 DOI: 10.1111/nep.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
AIM This prospective cohort study aimed to (i) examine stroke incidence and stroke subtypes by chronic kidney disease (CKD) stage, (ii) examine whether CKD patients with or without proteinuria have a high risk of stroke independent of traditional cardiovascular risk factors, and (iii) determine precise estimates of stroke risk by CKD stage while accounting for competing mortality risk. METHODS Participants were 2,023 patients enrolled in the Project in Sado for Total Health between June 2008 and December 2016 (55% men; mean age, 69 years), of whom 52% had CKD (stage 1-2, 10%; G3a, 48%; G3b, 17%; G4-5, 11%; and G5D, 14%). RESULTS During a median follow-up of 5.7 years, 157 participants developed stroke and 448 died without developing stroke. Most stroke cases were ischemic among non-dialysis-dependent CKD participants, but the relative frequency of ischemic stroke was near that of intracerebral hemorrhage among dialysis-dependent CKD participants. After adjustment, stage 1-2 (hazard ratio (HR), 2.97; 95% confidence interval (CI), 1.60 to 5.51) and stage G3-5 participants with proteinuria (HR, 2.50; 95% CI, 1.56 to 4.02), but not stage G3-5 participants without proteinuria (HR, 0.64; 95% CI, 0.38 to 1.08), had a higher stroke risk compared to non-CKD participants. In competing risk analyses, the association was attenuated but remained significant. CONCLUSION Although the distribution of stroke subtypes differed, CKD participants with proteinuria and those with CKD stage 5D had a 2- and 4-times higher risk of stroke, respectively, than that of non-CKD participants, after accounting for competing mortality risk and traditional risk factors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Minako Wakasugi
- Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akio Yokoseki
- Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | | | | | | | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Miwa K, Koga M, Nakai M, Yoshimura S, Sasahara Y, Koge J, Sonoda K, Ishigami A, Iwanaga Y, Miyamoto Y, Kobayashi S, Minematsu K, Toyoda K. Etiology and Outcome of Ischemic Stroke in Patients With Renal Impairment Including Chronic Kidney Disease: Japan Stroke Data Bank. Neurology 2022; 98:e1738-e1747. [PMID: 35260440 PMCID: PMC9071372 DOI: 10.1212/wnl.0000000000200153] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Chronic kidney disease is a worldwide public health problem that is recognized as an established risk factor for stroke. It remains unclear whether its distribution and clinical impact are consistent across ischemic stroke subtypes in patients with renal impairment. We examined whether renal impairment was associated with the proportion of each stroke subtype vs ischemic stroke overall and with functional outcomes after each stroke subtype. Methods Study participants were 10,392 adult patients with an acute stroke from the register of the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database, between October 2016 and December 2019, whose baseline serum creatinine levels or a dipstick proteinuria result were available. All ischemic strokes were classified according to the Trial of Org 10172 in Acute Stroke Treatment criteria. Unfavorable functional outcome was defined as modified Rankin Scale (mRS) score 3–6 at discharge. Mixed effect logistic regression was used to determine the relationship between the outcomes and the estimated glomerular filtration rate (eGFR), eGFR strata (<45, 45–59, ≥60 mL/min/1.73 m2), or dipstick proteinuria ≥1 adjusted for covariates. Results Overall, 2,419 (23%) patients had eGFR 45–59 mL/min/1.73 m2 and 1,976 (19%) had eGFR <45 mL/min/1.73 m2, including 185 patients (1.8%) receiving hemodialysis. Both eGFR 45–59 and eGFR <45 mL/min/1.73 m2 were associated with a higher proportion of cardioembolic stroke (odds ratio [OR], 1.21 [95% CI, 1.05–1.39] and 1.55 [1.34–1.79], respectively) and a lower proportion of small vessel occlusion (0.79 [0.69–0.90] and 0.68 [0.59–0.79], respectively). A similar association with the proportion of these 2 subtypes was proven in the analyses using decreased eGFR as continuous values. Both eGFR <45 mL/min/1.73 m2 and proteinuria were associated with unfavorable functional outcomes in patients with cardioembolic stroke (OR, 1.30 [95% CI, 1.01–1.69] and 3.18 [2.03–4.98], respectively) and small vessel occlusion (OR, 1.44 [1.01–2.07] and 2.08 [1.08–3.98], respectively). Discussion Renal impairment contributes to the different distributions and clinical effects across specific stroke subtypes, particularly evident in cardioembolic stroke and small vessel occlusion. This possibly indicates shared mechanisms of susceptibility and potentially enhancing pathways.
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Affiliation(s)
- Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yusuke Sasahara
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazutaka Sonoda
- Department of Neurology, Saiseikai Fukuoka Hospital, Fukuoka, Japan
| | - Akiko Ishigami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshitaka Iwanaga
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | | | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Kelly DM, Rothwell PM. Disentangling the Relationship Between Chronic Kidney Disease and Cognitive Disorders. Front Neurol 2022; 13:830064. [PMID: 35280286 PMCID: PMC8914950 DOI: 10.3389/fneur.2022.830064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a rapidly rising global health burden that affects nearly 40% of older adults. Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia, and thus represent a vulnerable population. It is currently unknown to what extent this risk may be attributable to a clustering of traditional risk factors such as hypertension and diabetes mellitus leading to a high prevalence of both symptomatic and subclinical ischaemic cerebrovascular lesions, or whether other potential mechanisms, including direct neuronal injury by uraemic toxins or dialysis-specific factors could also be involved. These knowledge gaps may lead to suboptimal prevention and treatment strategies being implemented in this group. In this review, we explore the mechanisms of susceptibility and risk in the relationship between CKD and cognitive disorders.
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Affiliation(s)
- Dearbhla M. Kelly
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter M. Rothwell
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2397] [Impact Index Per Article: 1198.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Lee SM, Ha E, Ryoo JH. Urine Protein Levels Predict Future Development of Cerebral Infarction in Koreans. Yonsei Med J 2022; 63:66-71. [PMID: 34913285 PMCID: PMC8688364 DOI: 10.3349/ymj.2022.63.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Proteinuria is a clinical sign of adverse cardiovascular outcomes, including stroke. We aimed to assess the relationship between proteinuria and the occurrence of cerebral infarction. MATERIALS AND METHODS In total, 208854 Koreans who participated in the 2009 medical examination were followed up until 2013 using the database of the National Health Insurance Service. The results of urine dipstick tests were utilized to assess proteinuria as absent, 1+, 2+, or ≥3+. The International Classification of Diseases code 163 was used to document cerebral infarction. RESULTS Between 2009 and 2013, 2383 cases (1.14%) of cerebral infarction occurred during 912772.9 person-years of follow-up. Hazard ratios for incident cerebral infarction increased with inceasing amounts of urine protein from 1.53 (1.23-1.90) in group 2 (1+), 1.67 (1.22-2.28) in group 3 (2+), and 2.66 (1.79-3.96) in group 4 (≥3+), compared to the reference group with little to no detectable urine protein (p<0.001, respectively). CONCLUSION An increase in urine protein levels was significantly related to the risk of developing cerebral infarction. Our results suggest that proteinuria might be a potential risk factor for cerebral infarction and that urine dipstick test analysis may be clinically useful for predicting stroke.
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Affiliation(s)
- Sang Min Lee
- Department of Psychiatry, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jae-Hong Ryoo
- Department of Occupational and Environmental Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
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21
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Jin M, Ren W, Zhang W, Liu L, Yin Z, Li D. Exploring the Underlying Mechanism of Shenyankangfu Tablet in the Treatment of Glomerulonephritis Through Network Pharmacology, Machine Learning, Molecular Docking, and Experimental Validation. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:4585-4601. [PMID: 34785888 PMCID: PMC8590514 DOI: 10.2147/dddt.s333209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022]
Abstract
Purpose This study aimed to explore the underlying mechanisms of Shenyankangfu tablet (SYKFT) in the treatment of glomerulonephritis (GN) based on network pharmacology, machine learning, molecular docking, and experimental validation. Methods The active ingredients and potential targets of SYKFT were obtained through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, the targets of GN were obtained through GeneCards, etc. Perl and Cytoscape were used to construct an herb-active ingredient–target network. Then, the clusterProfiler package of R was used for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. We also used the STRING platform and Cytoscape to construct a protein–protein interaction (PPI) network, as well as the SwissTargetPrediction server to predict the target protein of the core active ingredient based on machine-learning model. Molecular-docking analysis was further performed using AutoDock Vina and Pymol. Finally, we verified the effect of SYKFT on GN in vivo. Results A total of 154 active ingredients and 255 targets in SYKFT were screened, and 135 targets were identified to be related to GN. GO enrichment analysis indicated that biological processes were primarily associated with oxidative stress and cell proliferation. KEGG pathway analysis showed that these targets were involved mostly in infection-related and GN-related pathways. PPI network analysis identified 13 core targets of SYKFT. Results of machine-learning model suggested that STAT3 and AKT1 may be the key target. Results of molecular docking suggested that the main active components of SYKFT can be combined with various target proteins. In vivo experiments confirmed that SYKFT may alleviate renal pathological injury by regulating core genes, thereby reducing urinary protein. Conclusion This study demonstrated for the first time the multicomponent, multitarget, and multipathway characteristics of SYKFT for GN treatment.
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Affiliation(s)
- Meiling Jin
- Department of Nephrology, Beijing-Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.,Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Wenwen Ren
- Department of Nephrology, Beijing Ditan Hospital,Capital Medical University, Beijing, 100015, People's Republic of China
| | - Weiguang Zhang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Linchang Liu
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, 100853, People's Republic of China.,Department of Nephrology, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, 100039, People's Republic of China
| | - Zhiwei Yin
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing, 100853, People's Republic of China.,College of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Diangeng Li
- Department of Academic Research, Beijing-Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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22
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Wyld M, Webster AC. Chronic Kidney Disease is a Risk Factor for Stroke. J Stroke Cerebrovasc Dis 2021; 30:105730. [PMID: 33926795 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105730] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
Chronic kidney disease (CKD) is a sustained reduction in estimated glomerular filtration rate (eGFR), and/or presence of albuminuria. People with CKD have adverse cardiovascular outcomes including stroke. CKD and stroke share several risk factors, most notably older age, diabetes and hypertension, but CKD is also an independent risk factor for stroke. Relative burden of increased risk is worse for younger people and women, with <40 years with end stage CKD having more than 11 times the risk of their age-matched peers. Risk also varies by CKD treatment, with a risk peak for those starting dialysis, but dropping after the first month of treatment. Proposed mechanisms for increased risk are uraemia, cerebral blood flow dysregulation, vascular calcification, arterial stiffness, chronic inflammation, vascular access impacts, and for those on haemodialysis the use of anticoagulation to maintain dialysis circuits. Outcomes for people with CKD and stroke are poorer; functional outcomes may be impacted by reduced access to specialised stroke care. Stroke mortality is higher for those with CKD; with standardised mortality ratio more than three times higher than expected, but for some groups higher still (young women <40 years with a kidney transplant have 19 times the risk of stroke mortality than women without a transplant). Interventions to prevent and treat stroke lack the evidence base in CKD patients that is present for the general population.
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Affiliation(s)
- Melanie Wyld
- Centre of Transplant and Renal Research, Westmead Hospital, Westmead, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Angela C Webster
- Centre of Transplant and Renal Research, Westmead Hospital, Westmead, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 129a Edward Ford Building A27, NSW 2006, Australia; NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia.
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23
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Kelly DM, Rothwell PM. Impact of multimorbidity on risk and outcome of stroke: Lessons from chronic kidney disease. Int J Stroke 2020; 16:758-770. [PMID: 33243088 PMCID: PMC8521355 DOI: 10.1177/1747493020975250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With both an aging population and greater post-stroke survival, multimorbidity is a growing healthcare challenge, affecting over 40% of stroke patients, and rising rapidly and predictably with increasing age. Commonly defined as the co-occurrence of two or more chronic conditions, multimorbidity burden is a strong adverse prognostic factor, associated with greater short- and long-term stroke mortality, worse rehabilitation outcomes, and reduced use of secondary prevention. Chronic kidney disease can be considered as the archetypal comorbidity, being age-dependent and also affecting about 40% of stroke patients. Chronic kidney disease and stroke share very similar traditional cardiovascular risk factor profiles such as hypertension and diabetes, though novel chronic kidney disease-specific risk factors such as inflammation and oxidative stress have also been proposed. Using chronic kidney disease as an exemplar condition, we explore the mechanisms of risk in multimorbidity, implications for management, impact on stroke severity, and downstream consequences such as post-stroke cognitive impairment and dementia.
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Affiliation(s)
- Dearbhla M Kelly
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK
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24
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Hu Y, Lei M, Ke G, Huang X, Peng X, Zhong L, Fu P. Metformin Use and Risk of All-Cause Mortality and Cardiovascular Events in Patients With Chronic Kidney Disease-A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:559446. [PMID: 33117278 PMCID: PMC7575818 DOI: 10.3389/fendo.2020.559446] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
Background To evaluate whether metformin use assuredly alters overall all-cause death in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Methods Pubmed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from inception to Feb. 29, 2020 with no language restriction. All related articles comparing all-cause death of T2DM and CKD patients after metformin use (monotherapy or combination) versus non-metformin treatment were identified. Pooled risk ratios (RR) and 95% confidence intervals (CI) were computed using random-effects models regardless of the heterogeneity quantified by Cochrane χ2 and I2 statistics. Results Totally 13 studies (9 cohort studies [CSs], 3 subanalyses or post-hoc analyses of randomized controlled trials [RCTs], and 1 nested case-control article) involving 303,540 patients were included. Metformin-based treatments relative to any other measure displayed significantly lower risks of all-cause mortality (Pooled RRs 0.71, 95%CI 0.61 to 0.84; I2 = 79.0%) and cardiovascular events (Pooled RRs 0.76, 95%CI 0.60 to 0.97; I2 = 87.0%) in CKD patients at stage G1-3, with substantial heterogeneity. Metformin use was not significantly related with these end points in advanced CKD patients. Conclusions Metformin use is connected with significantly less risks of all-cause mortality and cardiovascular events in patients with T2DM and mild/moderate CKD. However, RCTs with large sample sizes are warranted in the future to assess whether these key benefits extend to later stages of CKD by dose adjustment.
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Affiliation(s)
- Yao Hu
- Department of Medicine Renal Division, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
- Department of Medicine Renal Division, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, China
| | - Min Lei
- Department of Medicine Renal Division, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, China
| | - Guibao Ke
- Department of Medicine Renal Division, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, China
| | - Xin Huang
- Department of Medicine Renal Division, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, China
| | - Xuan Peng
- Department of Medicine Renal Division, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, China
| | - Lihui Zhong
- Department of Medicine Renal Division, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Ping Fu
- Department of Medicine Renal Division, West China Hospital, West China School of Medicine, Sichuan University, Kidney Research Institute, Chengdu, China
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25
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Kelly DM, Li L, Burgess AI, Poole DL, Duerden JM, Rothwell PM. Associations of blood biomarkers with glomerular filtration rate in patients with TIA and stroke: population-based study. Stroke Vasc Neurol 2020; 6:48-56. [PMID: 32883874 PMCID: PMC8005904 DOI: 10.1136/svn-2020-000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background and purpose Non-traditional risk factors such as chronic inflammation, oxidative stress and thrombogenic factors are believed to contribute to the excess stroke risk in chronic kidney disease (CKD) by triggering vascular injury and endothelial dysfunction. We aimed to determine how well a panel of biomarkers representative of these factors would correlate with estimated glomerular filtration rate (eGFR) in patients with recent transient ischaemic attack (TIA) or stroke. We also investigated whether eGFR would confound previously reported associations between biomarkers and mortality. Methods We studied a panel of 16 blood biomarkers related to inflammation, thrombosis, atherogenesis and cardiac or neuronal cell damage in TIA or ischaemic stroke in a population-based study (Oxford Vascular Study). Biomarker levels were log-transformed and correlated with eGFR, adjusted for age. Cox proportional hazard models were used for survival analysis. Results Among 1297 patients with TIA or stroke, 52.7% (n=684) of patients had CKD (eGFR <60 mL/min/1.73 m2). There was a moderate correlation between log-eGFR and the log-transformed soluble tumour necrosis factor receptor-1 (R2=0.21), attenuating with adjustment for age (R2=0.12). There were moderate-to-strong correlations with markers of cardiac injury, N-terminal pro-brain natriuretic peptide and heart-type fatty acid binding protein (hFABP, R2=0.14 and 0.34, respectively). The strongest correlation after adjustment for age was between hFABP and eGFR (R2=0.20). Adjusting for eGFR did not impact any biomarker associations with mortality. Conclusions Correlations between biomarkers related to inflammation and thrombosis with renal dysfunction in the setting of cerebrovascular events were generally modest after adjustment for age, suggesting that putative risk factors such as chronic inflammation or coagulopathy are unlikely to be important stroke mechanisms in patients with CKD.
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Affiliation(s)
- Dearbhla M Kelly
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Linxin Li
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Annette I Burgess
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Deborah L Poole
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Julia M Duerden
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
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