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Cerebrovascular disease
Review
Disentangling the multiple links between renal dysfunction and cerebrovascular disease
  1. Dearbhla Kelly,
  2. Peter Malcolm Rothwell
  1. Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Dearbhla Kelly, Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK; Dearbhla.Kelly{at}ndcn.ox.ac.uk

Abstract

Chronic kidney disease (CKD) has a rapidly rising global prevalence, affecting as many as one-third of the population over the age of 75 years. CKD is a well-known risk factor for cardiovascular disease and, in particular, there is a strong association with stroke. Cohort studies and trials indicate that reduced glomerular filtration rate increases the risk of stroke by about 40% and that proteinuria increases the risk by about 70%. In addition, CKD is also strongly associated with subclinical cerebrovascular abnormalities, vascular cognitive impairment and dementia. The mechanisms responsible for these associations are currently unclear. CKD is associated with traditional risk factors such as hypertension, diabetes mellitus and atrial fibrillation, but non-traditional risk factors such as uraemia, oxidative stress, mineral and bone abnormalities, and dialysis-related factors, such as changes in cerebral blood flow or cardiac structure, are also postulated to play a role. Kidney disease can also impact and complicate the treatments used in acute stroke and in secondary prevention. In this review, we will outline our current understanding of the epidemiology and pathophysiology of cerebrovascular disease in CKD.

  • chronic kidney disease
  • stroke
  • hypertension
  • dialysis
  • dementia

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/jnnp-2019-320526

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    Footnotes

    • Contributors DMK performed the literature search, selected the relevant articles and wrote the first draft of the paper. PMR added further references, provided guidance for the discussion and revised the paper.

    • Funding Peter Rothwell has received funding from Wellcome Trust (Grant no: 104040/Z/14/Z), Wolfson Foundation, British Heart Foundation, and the National Institute for Health Research Oxford Biomedical Research Centre. Dearbhla Kelly has received a scholarship from the Irish Nephrology Society.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.