Impact of chronic kidney disease severity on causes of death after first-ever stroke: A population-based study using nationwide data linkage

PLoS One. 2020 Nov 19;15(11):e0241891. doi: 10.1371/journal.pone.0241891. eCollection 2020.

Abstract

Background: Stroke is prevalent in patients with chronic kidney disease (CKD) and is associated with high mortality, but the causes of death after stroke among different CKD stages are not well known.

Aims: We aimed to investigate whether the severity of CKD would impact on the causes of death after first-ever stroke.

Methods: This retrospective multicenter cohort study included stoke patients with CKD between 2007 and 2012. The cause of death and date of death were ascertained by linking the National Death Registry Database of Taiwan. Clinical outcomes, 1-month, and 1-year mortality rates, and major causes of death were compared according to five CKD stages (G1 to G5) in the ischemic and hemorrhagic stroke separately.

Results: Of these patients, 9,878 were first-ever ischemic stroke (IS) patients, and 1,387 were first-ever hemorrhagic stroke (HS) patients. Patients with CKD G5 had the highest one-year mortality rate with hazard ratio 5.28 [95%CI, 3.94-7.08] in IS and 3.03 [95%CI, 2.03-4.54] in HS when compared to G1 patients. Leading causes of one-year death after IS were stroke, cancer, and pneumonia in early (G1-3) CKD patients, while diabetes mellitus, CKD, and stroke itself contributed to the major mortality in CKD G5 patients. An inverse association between eGFR decrement and the proportion of deaths caused by stroke itself was observed in CKD G2-5 patients after IS. Stroke was the leading cause of one-year death among all CKD patients after HS.

Conclusions: Asides from high mortality, late-stage CKD patients had different causes of death from early CKD patients after stroke. This study highlights the need to imply different treatment strategies in late-stage CKD post-stroke patients to improve their prognosis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Female
  • Glomerular Filtration Rate
  • Hemorrhagic Stroke / epidemiology*
  • Hemorrhagic Stroke / mortality
  • Humans
  • Information Storage and Retrieval
  • Ischemic Stroke / epidemiology*
  • Ischemic Stroke / mortality
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Registries
  • Renal Insufficiency, Chronic / physiopathology*
  • Retrospective Studies
  • Risk Factors
  • Taiwan / epidemiology

Grants and funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Chang Gung Medical Research Council CMRPG35072, 35073, 39082, 39083, CMRPG3B0611, CMPRG3A0352, CMRPG3B0111, CMRPG3F2211-2, CLRPG3D0044, and BMRP274. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.