Mechanisms of Stroke in Patients with Chronic Kidney Disease.
BACKGROUND
Given the increasing worldwide prevalence of chronic kidney disease (CKD), it is critical to decrease the associated risk of debilitating vascular complications, including stroke, congestive heart failure, myocardial infarction, and peripheral vascular disease. Treatment options for reducing the risk of all subtypes of stroke in patients with CKD remain limited. For patients with end-stage kidney disease (ESKD), novel applications of noninvasive imaging may help personalize the type of dialysis and dialysis prescription for patients at high-risk.


SUMMARY
This manuscript reviews the heightened risk of stroke in patients with nephropathy, including ischemic and hemorrhagic subtypes. Mechanisms associated with increased risk include alterations in cardiac output, platelet function, regional cerebral perfusion, accelerated systemic atherosclerosis, altered blood brain barrier, and disordered neurovascular coupling. There is great potential for noninvasive monitoring of the cerebral vasculature using transcranial Doppler (TCD) to reduce stroke risk, particularly in patients with ESKD. Key Messages: Compared to the general population, patients with CKD are at heightened risk for all subtypes of stroke. This is due to a multitude of mechanisms linking nephropathy with altered cerebral perfusion, cerebral neurovascular coupling, and blood vessel integrity. Intracranial imaging is not currently standard of care practice in patients with CKD or ESKD. TCD may provide clinicians real-time and noninvasive measurement of brain perfusion. This could be useful for assessing risk of stroke in patients' initiating dialysis, individualizing dialysis prescriptions, and potentially reducing rates of cerebrovascular disease and stroke in high-risk patients.
['Ghoshal|Shivani|S|', 'Freedman|Barry I|BI|']
D001921:Brain D002545:Brain Ischemia D002543:Cerebral Hemorrhage D006439:Hemodynamics D006801:Humans D007668:Kidney D007676:Kidney Failure, Chronic D010477:Perfusion D006435:Renal Dialysis D051436:Renal Insufficiency, Chronic D012307:Risk Factors D020521:Stroke D018608:Ultrasonography, Doppler
Stroke Chronic kidney disease Arteriosclerosis Cerebral autoregulation Cerebral blood flow