Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

ABSTRACT Chronic Kidney Disease (CKD) is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in CKD patients, accounting for this association. However, factors unique to these patients, such as uraemia, oxidative stress, mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with CKD, especially those who are dialysis-dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventative and therapeutic interventions for stroke in the general population. In this review, we will explore the complexities and challenges of these interventions in the renal population.