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Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it?
Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5–30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore imp...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Medknow Publications & Media Pvt Ltd
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434678/ https://www.ncbi.nlm.nih.gov/pubmed/28553032 http://dx.doi.org/10.4103/0971-4065.202405 |
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author | Nayak-Rao, S. Shenoy, M. P. |
author_facet | Nayak-Rao, S. Shenoy, M. P. |
author_sort | Nayak-Rao, S. |
collection | PubMed |
description | Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5–30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore important to understand the factors that predispose to stroke in this vulnerable population to better apply preventive strategies. The heightened risk of stroke in CKD represents the interplay of the vascular co-morbidities that occur with renal impairment and factors specific to renal failure such as malnutrition-inflammation-atherosclerosis complex, the effect of uremic toxins, dialysis techniques, vascular access, and the use of anticoagulants to maintain flow in the extracorporeal circuit. Old age, hypertension, diabetes, and previous cerebrovascular disease are all risk factors for stroke with the period of dialysis initiation constituting the highest risk period for developing new stroke. Patients with CKD-stage 3–5 have worse survival and diminished functional outcomes following stroke. Thrombolytic therapy for stroke in CKD has shown an increased risk of symptomatic intracranial hemorrhage or serious systemic hemorrhage, and the therapeutic effects may be attenuated. Benefit of statin therapy in dialysis patient as preventive therapy has not been shown to be beneficial. Control of hypertension and the judicious use of antiplatelet agents form the mainstay of stroke prevention. The benefit of antiplatelet therapies and oral anticoagulants has to be balanced against the real and increased risk of bleeding that is most evident in dialysis cohorts. An increased risk of vascular calcification particularly intracerebral vascular calcification has been seen in patientsreceiving warfarin as prophylaxis in atrial fibrillation. Newer anticoagulants have not been tested in patients with glomerular filtration rate <30 ml/min and hence have to be used with caution. This article is a review of stroke in patients with CKD and approach to managing it. |
format | Online Article Text |
id | pubmed-5434678 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-54346782017-05-26 Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? Nayak-Rao, S. Shenoy, M. P. Indian J Nephrol Review Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5–30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore important to understand the factors that predispose to stroke in this vulnerable population to better apply preventive strategies. The heightened risk of stroke in CKD represents the interplay of the vascular co-morbidities that occur with renal impairment and factors specific to renal failure such as malnutrition-inflammation-atherosclerosis complex, the effect of uremic toxins, dialysis techniques, vascular access, and the use of anticoagulants to maintain flow in the extracorporeal circuit. Old age, hypertension, diabetes, and previous cerebrovascular disease are all risk factors for stroke with the period of dialysis initiation constituting the highest risk period for developing new stroke. Patients with CKD-stage 3–5 have worse survival and diminished functional outcomes following stroke. Thrombolytic therapy for stroke in CKD has shown an increased risk of symptomatic intracranial hemorrhage or serious systemic hemorrhage, and the therapeutic effects may be attenuated. Benefit of statin therapy in dialysis patient as preventive therapy has not been shown to be beneficial. Control of hypertension and the judicious use of antiplatelet agents form the mainstay of stroke prevention. The benefit of antiplatelet therapies and oral anticoagulants has to be balanced against the real and increased risk of bleeding that is most evident in dialysis cohorts. An increased risk of vascular calcification particularly intracerebral vascular calcification has been seen in patientsreceiving warfarin as prophylaxis in atrial fibrillation. Newer anticoagulants have not been tested in patients with glomerular filtration rate <30 ml/min and hence have to be used with caution. This article is a review of stroke in patients with CKD and approach to managing it. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5434678/ /pubmed/28553032 http://dx.doi.org/10.4103/0971-4065.202405 Text en Copyright: © 2017 Indian Journal of Nephrology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Review Nayak-Rao, S. Shenoy, M. P. Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? |
title | Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? |
title_full | Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? |
title_fullStr | Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? |
title_full_unstemmed | Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? |
title_short | Stroke in Patients with Chronic Kidney Disease…: How do we Approach and Manage it? |
title_sort | stroke in patients with chronic kidney disease…: how do we approach and manage it? |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434678/ https://www.ncbi.nlm.nih.gov/pubmed/28553032 http://dx.doi.org/10.4103/0971-4065.202405 |
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