title: Stroke and Risks of Development and Progression of Kidney Diseases and End-Stage Renal Disease: A Nationwide Population-Based Cohort Study.
abstract: BACKGROUND
  There is little information about the association between stroke and kidney diseases. We aimed to investigate the impact of stroke on long-term renal outcomes.
  
  
  METHODS
  In this large population-based retrospective cohort study, we identified 100,353 subjects registered in the National Health Insurance Research Database of Taiwan from January 1, 2000, through December 31, 2012, including 33,451 stroke patients and 66,902 age-, sex- and Charlson's comorbidity index score-matched controls.
  
  
  RESULTS
  The incidence rate of chronic kidney disease (CKD) was higher in the stroke than in the control cohort (17.5 vs. 9.06 per 1000 person-years). After multivariate adjustment, the risk of developing CKD was significantly higher in patients with stroke (adjusted hazard ratio [aHR] 1.43, 95% confidence interval [CI] 1.36-1.50, P<0.001). Subgroup analysis showed that stroke patients <50 years (aHR 1.61, P<0.001) and those with concomitant diabetes mellitus (aHR 2.12, P<0.001), hyperlipidemia (aHR 1.53, P<0.001) or gout (aHR 1.84, P<0.001) were at higher risk of incident CKD. Additionally, the risks of progression to advanced CKD and end-stage renal disease (ESRD) were significantly higher for stroke patients (aHRs, 1.22 and 1.30; P = 0.04 and P = 0.008, respectively), independent of age, sex, comorbidities and long-term medications.
  
  
  CONCLUSIONS
  Stroke is associated with higher risks for incident CKD, decline in renal function and ESRD. Younger stroke patients, as well as those with concomitant diabetes mellitus, hyperlipidemia or gout are at greater risk for kidney diseases.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chew-Teng
authors.initials: CT
authors.lastname: Kor
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.affiliation: Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan.
authors.forename: Ie-Bin
authors.initials: IeB
authors.lastname: Lian
authors.affiliation: Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Tao-Hsiang
authors.initials: TH
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ping-Fang
authors.initials: PF
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.|Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-Chu
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013624:Taiwan; D016896:Treatment Outcome