Is CKD an Independent Risk Factor for Pre- and Post-stroke Dementia?

Pavankumar Kamat

Disclosures

January 27, 2022

Takeaway

  • In patients with transient ischaemic attack (TIA) and stroke, pre-dialysis chronic kidney disease (CKD) was not independently associated with a higher risk of either pre- or post-stroke dementia.

Why This Matters

  • Future studies should determine whether any additional unique mechanisms or pathways are involved in the development of late-onset dementia in patients with CKD and minor stroke events.

Study Design

  • The study included 2305 patients with TIA and stroke from the Oxford Vascular Study, an ongoing prospective, population-based cohort study (2002-2012).

  • Associations between CKD (estimated glomerular filtration rate of <60 mL/min/1.73m2) and dementia before and after TIA and stroke were evaluated.

  • Funding: None.

Key Results

  • Of 2305 patients with TIA and stroke, 1174 (50.9%) were diagnosed with CKD.

  • In the unadjusted analysis, CKD was strongly associated with a higher risk of pre-stroke dementia (OR 2.04; 95% CI 1.52 to 2.72) and post-stroke dementia (HR 2.01; 95% CI 1.65 to 2.44; P<0.001 for both).

  • However, the associations lost significance after adjustment for confounders:

    • pre-stroke dementia (adjusted OR [aOR] 0.92; 95% CI 0.65 to 1.31; P=0.65); and

    • post-stroke dementia (aOR 1.09; 95% CI 0.85 to 1.39; P=0.50).

  • Similarly, in the competing risk model, CKD was associated with a higher risk of post-stroke (subdistribution HR [SHR] 1.74; 95% CI 1.43 to 2.12; P<0.001), but this association diminished after adjustment for confounders (adjusted SHR [aSHR] 1.01; 95% CI 0.78 to 1.33; P=0.92).

  • CKD had a stronger association with late post-stroke dementia (>1 year; SHR 2.32; 95% CI 1.70 to 3.17), particularly following TIA and minor stroke (SHR 3.08; 95% CI 2.05 to 4.64; P<0.001 for both).

  • This association too diminished after adjustment for confounders (aSHR 1.53; 95% CI 0.90 to 2.60; P=0.12).

Limitations

  • Pre-stroke dementia was diagnosed retrospectively.

Kelly DM, Pendlebury ST, Rothwell PM. Associations of Chronic Kidney Disease With Dementia Before and After Transient Ischemic Attack and Stroke: Population-Based Cohort Study. Neurology. 2022 Jan 07 [Epub ahead of print]. doi: 10.1212/WNL.0000000000013205. PMID: 34996878 View abstract.

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