Skip to main content
SpringerLink
Log in

Stroke

  • Chapter
Cardiorenal Syndrome

  • 1078 Accesses

Abstract

Stroke is a devastating co-morbidity in chronic kidney disease that is several -fold more common than in the general population. Although traditional cardiovascular risk factors account for much of the stroke risk in CKD, some risk factors like anemia and dyslipidemia are challenging to address in view of recent clinical trial data that do not seem to provide the full degree of expected benefit from risk factor correction as reviewed herein. Others such as hypertension and proteinuria reduction remain mainstays in stroke prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Lloyd-Jones D, Adams R, Carnethon M et al (2009) Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119:e21–181

    Article  PubMed  Google Scholar 

  2. U.S. Renal Data System USRDS (2007) Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

    Google Scholar 

  3. Townsend RR (2008) Stroke in chronic kidney disease: prevention and management. Clin J Am Soc Nephrol 3(Suppl 1):S11–S16

    Article  CAS  PubMed  Google Scholar 

  4. Wannamethee SG, Shaper AG, Perry IJ (1997) Serum creatinine concentration and risk of cardiovascular disease: a possible marker for increased risk of stroke. Stroke 28:557–563

    CAS  PubMed  Google Scholar 

  5. Rinkel GJ (2005) Intracranial aneurysm screening: indications and advice for practice. Lancet Neurol 4:122–128

    Article  PubMed  Google Scholar 

  6. Yahalom G, Schwartz R, Schwammenthal Y et al (2009) Chronic kidney disease and clinical outcome in patients with acute stroke. Stroke 40:1296–1303

    Article  PubMed  Google Scholar 

  7. Staessen JA, Wang JG, Thijs L (2003) Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens 21:1055–1076

    Article  CAS  PubMed  Google Scholar 

  8. Sutherland GR, Auer RN (2006) Primary intracerebral hemorrhage. J Clin Neurosci 13:511–517

    Google Scholar 

  9. (1995) Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet 346: 1647–1653

    Google Scholar 

  10. Amarenco P, Lavallee P, Touboul PJ (2004) Stroke prevention, blood cholesterol, and statins. Lancet Neurol 3:271–278

    Article  CAS  PubMed  Google Scholar 

  11. Ariesen MJ, Claus SP, Rinkel GJ et al (2003) Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34:2060–2065

    Article  CAS  PubMed  Google Scholar 

  12. Foley RN, Parfrey PS, Harnett JD et al (1996) The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis 28:53–61

    Article  CAS  PubMed  Google Scholar 

  13. Sarnak MJ, Tighiouart H, Manjunath G et al (2002) Anemia as a risk factor for cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol 40:27–33

    Article  PubMed  Google Scholar 

  14. Abramson JL, Jurkovitz CT, Vaccarino V et al (2003) Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int 64:610–615

    Article  PubMed  Google Scholar 

  15. Metivier F, Marchais SJ, Guerin AP et al (2000) Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant 15(Suppl 3):14–18

    PubMed  Google Scholar 

  16. Ninomiya T, Perkovic V, Verdon C et al (2009) Proteinuria and stroke: a meta-analysis of cohort studies. Am J Kidney Dis 53:417–425

    Article  PubMed  Google Scholar 

  17. De Zeeuw D, Remuzzi G, Parving HH et al (2004) Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 110:921–927

    Article  PubMed  Google Scholar 

  18. Olsen MH, Wachtell K, Ibsen H et al (2006) Reductions in albuminuria and in electrocardiographic left ventricular hypertrophy independently improve prognosis in hypertension: the LIFE study. J Hypertens 24:775–781

    Article  CAS  PubMed  Google Scholar 

  19. Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252

    Article  CAS  PubMed  Google Scholar 

  20. Mancia G, De Backer G, Dominiczak A et al (2007) 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187

    Article  CAS  PubMed  Google Scholar 

  21. Lindholm LH, Carlberg B, Samuelsson O (2005) Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 366:1545–1553

    Article  CAS  PubMed  Google Scholar 

  22. Li J, Culman J, Hortnagl H et al (2005) Angiotensin AT2 receptor protects against cerebral ischemia-induced neuronal injury. FASEB J 19:617–619

    CAS  PubMed  Google Scholar 

  23. Reboldi G, Angeli F, Cavallini C et al (2008) Comparison between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk of myocardial infarction, stroke and death: a meta-analysis. J Hypertens 26:1282–1289

    Article  CAS  PubMed  Google Scholar 

  24. Chrysant SG (2005) Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence. J Hum Hypertens 19:923–931

    Article  CAS  PubMed  Google Scholar 

  25. Weiner DE, Tighiouart H, Levey AS et al (2007) Lowest systolic blood pressure is associated with stroke in stages 3 to 4 chronic kidney disease. J Am Soc Nephrol 18:960–966

    Article  PubMed  Google Scholar 

  26. Ninomiya T, Perkovic V, Gallagher M et al (2008) Lower blood pressure and risk of recurrent stroke in patients with chronic kidney disease: PROGRESS trial. Kidney Int 73:963–970

    Article  CAS  PubMed  Google Scholar 

  27. Segall L, Oprisiu R, Fournier A et al (2008) Antihypertensive treatment and stroke prevention in patients with and without chronic kidney disease: a review of controlled trials. J Nephrol 21:374–383

    CAS  PubMed  Google Scholar 

  28. Tonelli M, Moye L, Sacks FM et al (2003) Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency. Ann Intern Med 138:98–104

    CAS  PubMed  Google Scholar 

  29. Wanner C, Krane V, Marz W et al (2005) Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 353:238–248

    Article  CAS  PubMed  Google Scholar 

  30. Fellstrom BC, Jardine AG, Schmieder RE et al (2009) Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 360:1395–1407

    Article  CAS  PubMed  Google Scholar 

  31. Koren MJ, Davidson MH, Wilson DJ et al (2009) Focused atorvastatin therapy in managedcare patients with coronary heart disease and CKD. Am J Kidney Dis 53:741–750

    Article  CAS  PubMed  Google Scholar 

  32. Wanner C (2009) Statin effects in CKD: is there a “point of no return”? Am J Kidney Dis 53:723–725

    Article  PubMed  Google Scholar 

  33. Landray M, Baigent C, Leaper C et al (2006) The second United Kingdom Heart and Renal Protection (UK-HARP-II) Study: a randomized controlled study of the biochemical safety and efficacy of adding ezetimibe to simvastatin as initial therapy among patients with CKD. Am J Kidney Dis 47:385–395

    Article  CAS  PubMed  Google Scholar 

  34. Kidney Disease Outcomes Quality Initiative (2007) KDOQI clinical practice guideline and clinical practice recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 50:471–530

    Article  Google Scholar 

  35. Singh AK, Szczech L, Tang KL et al (2006) Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 355:2085–2098

    Article  CAS  PubMed  Google Scholar 

  36. Pfeffer MA, Burdmann EA, Chen, CY et al (2009) Trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361:2019–2032

    Article  PubMed  Google Scholar 

  37. Bhuriya R, Li S, Chen SC et al (2009) Plasma parathyroid hormone level and prevalent cardiovascular disease in CKD stages 3 and 4: an analysis from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 53:S3–10

    Article  Google Scholar 

  38. London GM, Guerin AP, Verbeke FH et al (2007) Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol 18:613–620

    Article  CAS  PubMed  Google Scholar 

  39. Whaley-Connell A, Sowers JR, McCullough PA et al (2009) Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES). Am J Kidney Dis 53:S11–S21

    Article  CAS  PubMed  Google Scholar 

  40. Khella SL (2008) New insights into stroke in chronic kidney disease. Adv Chronic Kidney Dis 15:338–346

    Article  PubMed  Google Scholar 

  41. CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339

    Article  Google Scholar 

  42. Kaufman JS, O’Connor TZ, Zhang JH et al (2003) Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. J Am Soc Nephrol 14: 2313–2321

    Article  CAS  PubMed  Google Scholar 

  43. Diener HC, Cunha L, Forbes C et al (1996) European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 143:1–13

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Mario F. Rubin

  2. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Raymond R. Townsend

Authors
  1. Mario F. Rubin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raymond R. Townsend
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Adel E. Berbari

  2. Clinica Medica Department of Clinical Medicine and Prevention, University of Milano-Bicocca San Gerardo Hospital, Monza, Milan, Italy

    Giuseppe Mancia

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Italia

About this chapter

Cite this chapter

Rubin, M.F., Townsend, R.R. (2010). Stroke. In: Berbari, A.E., Mancia, G. (eds) Cardiorenal Syndrome. Springer, Milano. https://doi.org/10.1007/978-88-470-1463-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1463-3_15

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1462-6

  • Online ISBN: 978-88-470-1463-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation