title: Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) has been linked to higher stroke risk. Anemia is a common consequence of CKD, and recent evidence suggests anemia may increase risk of cardiovascular events. The combined effect of CKD and anemia on stroke risk, however, has not been investigated thoroughly. We analyzed data from a middle-aged, community-based cohort to determine if CKD and anemia interacted to affect stroke risk.
  
  
  METHODS
  Data on 13,716 participants in the prospective Atherosclerosis Risk in Communities (ARIC) Study were analyzed to assess the joint effect of CKD and anemia on risk of incident stroke during a 9-year follow-up period. CKD was defined as a creatinine clearance of <60 mL/min. Anemia was defined as hemoglobin levels of <13 g/dL for men or <12 g/dL for women.
  
  
  RESULTS
  Overall, CKD was associated with an increase in stroke risk after adjustment for other factors [hazard ratio HR) 1.81; 95% CI 1.26 to 2.02]. However, this association was modified substantially by anemia. In the presence of anemia, CKD was associated with a substantially higher risk of stroke compared to no CKD (HR 5.43; 95% CI 2.04 to 14.41). In contrast, when anemia was not present, CKD was associated with only a modest, nonsignificant elevation in stroke risk (HR 1.41; 95% CI 0.93 to 2.14). The interaction between CKD and anemia on risk of stroke was statistically significant (P < 0.01).
  
  
  CONCLUSIONS
  Among middle-aged, community-based persons, the combination of CKD and anemia was associated with a substantial increase in stroke risk, independent of other known risk factors for stroke.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30306, USA. jabram3@emory.edu
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Abramson
authors.forename: Claudine T
authors.initials: CT
authors.lastname: Jurkovitz
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: William
authors.initials: W
authors.lastname: McClellan
mesh_terms: D000740:Anemia / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*