title: Chronic kidney disease and drinking status in relation to risks of stroke and its subtypes: the Circulatory Risk in Communities Study (CIRCS).
abstract: OBJECTIVE
  Several epidemiological studies have established an association between chronic kidney disease (CKD), based on estimated glomerular filtration rate (GFR), and risk of stroke. However, sex-specific evidence for the relationship between CKD and risk of stroke and its subtypes is still limited.
  
  
  METHODS
  We conducted a prospective cohort study of 12 222 Japanese men and women age 40 to 69 years living in 4 communities under systematic surveillance of stroke incidence to determine the relationship between CKD and risk of stroke and its subtypes.
  
  
  RESULTS
  During the 17-year follow-up, there were 566 strokes (327 ischemic and 186 hemorrhagic strokes). GFR was inversely associated with age- and community-adjusted risk of total stroke for both men and women. Compared with the reference group without CKD (GFR ≥60 mL/min per 1.73m(2)), the adjusted risks of total stroke for subjects with CKD (GFR <60 mL/min per 1.73m(2)) were 1.63 (1.22-2.17) for men and 1.51 (1.13-2.02) for women. Excess risk of stroke associated with CKD was identified primarily for hemorrhagic stroke among men and for ischemic stroke among women. After adjustment for traditional cardiovascular risk factors, associations remained statistically significant. When stratified by drinking status, excess risk of hemorrhagic stroke with CKD was confined to drinkers; adjusted risks were 4.18 (2.31-7.57) for men and 7.00 (1.92-25.56) for women.
  
  
  CONCLUSIONS
  CKD was associated with increased risk of hemorrhagic stroke for men, and of ischemic stroke for women. This sex difference may partly be explained by the difference in prevalence of drinkers between men and women.
authors.affiliation: School of Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka 565-0871 Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Kenji
authors.initials: K
authors.lastname: Maeda
authors.forename: Hironori
authors.initials: H
authors.lastname: Imano
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohira
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kitamura
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kiyama
authors.forename: Takeo
authors.initials: T
authors.lastname: Okada
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimamoto
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000503:physiopathology; D044466:Asian People; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007564:Japan; D007674:Kidney Diseases / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology