Epidemiology, therapy, and prognosis after stroke in chronic kidney disease

Ischemic stroke is one of the most common causes of death worldwide. Its occurrence closely correlates with the severity of chronic kidney disease (CKD) and albuminuria. Pharmacological prevention of stroke in patients with mild-to-moderate CKD does not differ significantly from the general recommendations. However, the beneficial effect of statins on reducing the risk of stroke remains unproven in patients with advanced CKD and on dialysis. The use of acetylsalicylic acid and oral anticoagulants increases the risk of serious bleeding complications and requires special care and additional monitoring. CKD cannot be considered a contraindication for carotid artery endarterectomy or stenting in patients with symptomatic carotid artery stenosis; likewise, CKD cannot be a contraindication for thrombolysis and thrombectomy in ischemic stroke patients. Admittedly, all these procedures are associated with an increased risk of adverse events compared to non-CKD patients. Early thrombolysis and especially thrombectomy improve poor outcomes in CKD patients. Post-stroke supportive treatment of CKD patients does not differ from the general standards, but the nephrological burden should be taken into consideration, especially when using antihypertensive, anticonvulsant, or edemareducing drugs. Statin use after stroke reduces 3-month mortality. Further research is needed to create specific CKD therapeutic algorithms for more effective management of ischemic stroke in patients with severe CKD and on dialysis