Article ; Online: Controversies: Stroke Prevention in Chronic Kidney Disease.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
2021 Volume 30, Issue 9, Page(s) 105679
Abstract: Risk of both ischemic and hemorrhagic stroke is increased in the chronic kidney disease (CKD) population, particularly in end-stage kidney disease patients. Uremic factors that contribute to stroke risk include blood pressure variability, vascular ... ...
| Abstract | Risk of both ischemic and hemorrhagic stroke is increased in the chronic kidney disease (CKD) population, particularly in end-stage kidney disease patients. Uremic factors that contribute to stroke risk include blood pressure variability, vascular calcification, build-up of vascular toxins, chronic inflammation, platelet dysfunction and increased brain microbleeds. This paper discusses the controversial evidence for stroke prevention strategies including blood pressure control, statins, antiplatelet agents, and anticoagulation in the CKD population. Only a few randomized clinical trials included patients with advanced CKD, thus evidence is derived mostly from observational cohorts and real-world data. Overall, targeting a lower systolic blood pressure below 120 mmHg and statin prescription do not appear to decrease stroke risk in CKD. Antiplatelet agents have not shown a clear benefit for secondary stroke prevention, but aspirin may reduce incident stroke in hypertensive CKD stage 3B-5 patients. Observational data suggests that the factor Xa inhibitor apixaban has a favorable profile over warfarin in dialysis patients with atrial fibrillation; apixaban being associated with lower stroke risk and fewer major bleeding events. |
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| MeSH term(s) | Administration, Oral ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Antihypertensive Agents/adverse effects ; Antihypertensive Agents/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/epidemiology ; Dyslipidemias/drug therapy ; Dyslipidemias/epidemiology ; Humans ; Hypertension/drug therapy ; Hypertension/epidemiology ; Hypolipidemic Agents/adverse effects ; Hypolipidemic Agents/therapeutic use ; Platelet Aggregation Inhibitors/adverse effects ; Platelet Aggregation Inhibitors/therapeutic use ; Primary Prevention ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/drug therapy ; Renal Insufficiency, Chronic/epidemiology ; Risk Assessment ; Risk Factors ; Secondary Prevention ; Stroke/diagnosis ; Stroke/epidemiology ; Stroke/prevention & control ; Treatment Outcome |
| Chemical Substances | Anticoagulants ; Antihypertensive Agents ; Hypolipidemic Agents ; Platelet Aggregation Inhibitors |
| Language | English |
| Publishing date | 2021-02-25 |
| Publishing country | United States |
| Document type | Journal Article ; Review |
| ZDB-ID | 1131675-5 |
| ISSN | 1532-8511 ; 1052-3057 |
| ISSN (online) | 1532-8511 |
| ISSN | 1052-3057 |
| DOI | 10.1016/j.jstrokecerebrovasdis.2021.105679 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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