People with chronic kidney disease (CKD) have an increased risk of stroke however its magnitude and the link with albuminuria levels and glomerular filtration rate (GFR) remain unclear. Now, in a study entitled “Chronic kidney disease and the risk of stroke: a systematic review and meta-analysis”, published in the journal Nephrology Dialysis Transplantation, a team of researchers have determined that the risk of stroke increases upon a decline in GFR and increased albuminuria.
Stroke and chronic kidney disease (CKD) are major global health problems. One in every five women and one in every four men will suffer a stroke by the age of 85 years, accounting for the second main cause of death and the primary cause of chronic neurological disability globally.
CKD and stroke share common cardiovascular risk factors such as smoking, diabetes, high blood pressure and high cholesterol. To address how the magnitude of stroke risk changes as CKD progresses, and whether albuminuria and GFR act alone or in combination to modify this link, the research team led by Philip Masson from the Sydney School of Public Health, University of Sydney in Australia, performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies that estimated the association between GFR and/or albuminuria and the risk of stroke.
A total of 83 studies were identified reporting a total of 30 392 strokes. The results showed an inverse linear relationship between GFR and stroke risk, which increased 7% for every 10 mL/min/1.73 m2 of GFR decrease. Furthermore, a 25 mg/mmol increase in albumin–creatinine ratio was associated with a 10% increase in stroke risk,with the effect of albuminuria proving to be independent of GFR.
The researchers determined that these results were not different across subtypes of stroke, sex and varying prevalence of cardiovascular risk factors. Based on their findings the researchers wrote “Our data suggest that each year up to 4% of all strokes (31 800 in the USA) may be attributable to having a GFR <90 mL/min/1.73 m2, having any degree of albuminuria may account for 6% (47 770) of all strokes, and that as many as 10 000 (1.2%) strokes could be prevented if people with microalbuminuria received an angiotensin-converting enzyme inhibitor”. These data suggest that CKD staging might be a useful clinical method to identify patients who may benefit most from interventions to reduce the risk of cardiovascular events.