New insights into stroke in chronic kidney disease.
Patients with chronic kidney disease (CKD) are predisposed to stroke, especially as the estimated glomerular filtration rate decreases. This update reviews the pathologic mechanisms particular to this stroke population. The treatment for primary and secondary prevention of stroke is reviewed with respect to antiplatelet agents, anticoagulants, surgery, and carotid stenting. The control of chronic hypertension is particularly important in reducing stroke risk in CKD. In patients with prior stroke from atherosclerosis, antiplatelet agents are most beneficial in reducing secondary stroke risk. Those with atrial fibrillation and CKD may benefit from warfarin anticoagulation. Statins in CKD for stroke reduction in diabetics receiving dialysis are not useful, and the data are pending for their use in stroke reduction in the general CKD population. In carefully selected cases, carotid endarterectomy can be a treatment. The data on carotid stenting are conflicting.
Khella
Sami L
SL
Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA, USA. Sami.Khella@uphs.upenn.edu
D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D016019:Survival Analysis
D000925:Anticoagulants; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors