Introduction:
Chronic kidney disease(CKD) is an independent risk factor for the development of cerebrovascular disease. Hypertension, Diabetes mellitus, Atherosclerosis, heparin usage, hyperlipidemia, hyperhomocystenemia, and protein malnutrition are cited as risk factors for stroke by several studies . Stroke may manifest as infarction, haemorrhage and sometimes in combination of these two. Infarcts were found to arise due to involvement of carotid or vertebrobasilar arteries. In hemorrhagic strokes the bleed was common in thalamic and basal ganglia regions. Stroke in chronic dialysis patients is associated with high mortality.
Methods:
Type of study: Retrospective observational study.
Inclusion criteria: All patients of CKD admitted with stroke from June 2016 to June 2024.
Exclusion criteria: Patients with inadequate medical data and those who left against medical advice.
Setting: Department of Nephrology, Gandhi Medical College, Secunderabad.
The diagnosis of stroke was made on the basis of history, physical examination and CT Brain. MRI brain was done depending on the clinical need. The causes of stroke were broadly subdivided into ischemic and hemorrhagic categories depending on radiological appearance Patients were carefully assessed for their risk factor status. Management was according to the standard protocol of the institution, and the outcome status was assessed
Results:
Results:-
Table 1: Baseline characteristics
|
|
MALE (n=154)
|
FEMALE (n=94)
|
p-value
|
|
Age (Years) (Mean ± SD)
|
51.7± 12.1
|
45.3 ± 12.6
|
0.012*
|
|
SBP mmHg (Mean ± SD)
|
160.6 ± 26.0
|
162.4 ± 30.6
|
0.772
|
|
DBP mmHg (Mean ± SD)
|
96.9 ± 18.24
|
99.6 ± 16.9
|
0.516
|
|
CKD Duration (Months) (Mean ± SD)
|
12.3 ±13.6
|
12.3 ± 15.4
|
0.64
|
|
Risk Factors [n (%)]
|
|
|
|
|
Hypertension
|
108(70.1%)
|
77(81.9%)
|
0.001*
|
|
DM
|
78(50.6%)
|
59(62.7%)
|
0.001*
|
|
Anemia
|
131(85.1%)
|
74(78.7%)
|
0.216
|
|
Type Of CVA
|
|
|
|
|
Ischemic
|
101(65.6%)
|
61(64.9%)
|
|
|
Hemorrhagic
|
53(34.4%)
|
33(35.1%)
|
|
|
Survival [n (%)]
|
82 (53.2%)
|
39 (41.5%)
|
|
|
Biochemical profile#
|
|
|
|
|
S.Creatinine
|
6.1+1.4
|
6.2+2.1
|
0.41
|
|
Hemoglobin
|
9.8+1.6
|
8.15+2.0
|
0.46
|
|
TLC
|
17.0+10.5
|
17.4+ 9.4
|
0.96
|
|
PLT
|
1.45+1.09
|
1.2+1.12
|
0.07
|
|
pH
|
7.3+0.1
|
7.2+0.1
|
0.001*
|
|
PCO2
|
26+6
|
26+10
|
0.28
|
|
HCO3
|
13+2.7
|
12+2.6
|
0.006*
|
|
S.K
|
4.7+1
|
4.9+1.2
|
0.031*
|
|
S.ALB
|
3.6+0.9
|
3.2+0.7
|
0.003*
|
|
TB
|
1+0.65
|
1.2+1.1
|
0.001*
|
Table 2: Ischemic vs Hemorrhagic stroke comparison
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|
ISCHEMIC (n=162)
|
HEMORRHAGIC (n=86)
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p-value
|
|
Gender [n (%)]
|
|
|
|
|
Male [n=154]
|
102(66.2%)
|
52(33.8%)
|
|
|
Female [n=94]
|
60(63.8%)
|
34(36.2%)
|
|
|
Age ( Years ) (Mean ± SD)
|
55.1± 10.2
|
48.6± 11.1
|
0.01*
|
|
HTN [n (%)]
|
105 (64.8%)
|
83 (96.5%)
|
0.163
|
|
Type 2 DM [n (%)]
|
74 (45.7%)
|
66 (76.7%)
|
0.373
|
|
SBP mmHg (Mean ± SD)
|
159.4 ± 28.4
|
174.3± 24.0
|
0.027*
|
|
DBP mmHg (Mean ± SD)
|
96.2 ± 17.5
|
106.5 ± 16.4
|
0.008*
|
|
Survival [n (%)]
|
91 (56.2%)
|
30 (34.9%)
|
0.067
|
|
Biochemical profile
|
|
|
|
|
S.Creatinine
|
6.8± 3.6
|
7.5± 2.7
|
0.093
|
|
Hb(g/dl) (Mean ± SD)
|
10.27 + 0.84
|
9.65 + 1.48
|
0.091
|
|
TLC
|
7.56 + 4.75
|
11.55 + 5.5
|
0.02
|
|
PLT
|
2.2 + 1.49
|
1.64 + 0.87
|
0.31
|
|
S.K
|
5.1 ± 0.7
|
5.2 ± 0.5
|
0.641
|
|
S.ALB
|
3.2 ± 0.30
|
3.1 ± 0.6
|
0.842
|
|
TB
|
0.9 ± 0.2
|
1.2 ± 1.5
|
0.324
|
Table 3: Survivors vs Non survivors
|
|
SURVIVAL
|
p-value
|
|
|
YES(n=121)
|
NO (n=127)
|
|
|
|
Gender [n (%)]
|
|
|
|
|
Male [n=154]
|
88 (57.1%)
|
66 (42.9%)
|
0.725
|
|
Female [n=94]
|
33 (35.1%)
|
61 (64.9%)
|
|
|
Age(Years) (Mean ± SD)
|
52.1± 13.7
|
54.2 ± 12.4
|
0.256
|
|
Ischemia [n (%)]
|
98 (81%)
|
64 (50.4%)
|
0.032*
|
|
Hemorrhage [n (%)]
|
23 (19%)
|
63 (49.6%)
|
|
|
Hypertension [n (%)]
|
116 (95.9%)
|
72 (56.7%)
|
0.354
|
|
DM [n (%)]
|
81 (66.9%)
|
59 (46.5%)
|
0.924
|
|
SBP mmHg (Mean ± SD)
|
160.7 ± 30.5
|
154.3± 21.5
|
0.033*
|
|
DBP mmHg (Mean ± SD)
|
93.4 ± 15.6
|
104.8 ± 14.3
|
0.014*
|
|
Biochemical profile
|
|
|
|
|
S. Creatinine (mg/dl) (Mean ± SD)
|
5.69+/-2.37
|
5.75+/-4.33
|
0.935
|
|
Hb(g/dl) (Mean ± SD)
|
9.4 ± 1.5
|
9.4 ± 1.7
|
0.322
|
|
TLC
|
9440.45 ± 5441.54
|
10412.43 ± 18260.41
|
0.482
|
|
PLT
|
1.40 ± 0.76
|
1.83 ± 0.85
|
0.781
|
Conclusions:
Conclusion:
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|
Our study
|
P Ramakrishna et al SVIMS, Tirupathi
|
long Man Tung et al, Thailand
|
|
Mean age ±SD(year)
|
50.87 ±12.3
|
63.59 ± 10.59
|
67.59 ± 12.59
|
|
Male:female
|
1.64:1
|
1.4:1
|
1.17:1
|
|
HTN
|
75.8%
|
88.8%
|
65.5%
|
|
DM
|
56.5%
|
48.1%
|
41.8%
|
|
Anemia
|
82.7%
|
81.4%
|
23.8%
|
|
Ischemia
|
65.3%
|
48.2%
|
60.6%
|
|
Hemorrhage
|
34.7%
|
40.7%
|
25.7%
|
|
Discharge
|
48.8%
|
70%
|
84.2%
|
• Males are more affected with stroke than females.
• Hypertension and anemia combined are major risk factors for stroke in CKD.
• Ischemic stroke (63.6%) is more common than hemorrhagic stroke in CKD patients.
• Males with higher age, Diabetes and Hypertension are associated with increased risk of stroke.
• Higher SBP and DBP are associated with hemorrhagic stroke.
• Survival in ischemic stroke is better than hemorrhagic stroke.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.