Does Chronic Kidney Disease Predict Stroke Risk Independent of Blood Pressure?
Key result
Chronic kidney disease (eGFR <60) was associated with increased stroke risk (RR 1.73; 95% CI 1.57-1.90), but this was attenuated after adjustment for multiple blood pressure measurements (RR 1.10).
Why the study?
Low glomerular filtration rate appears to independently increase stroke risk, but the impact of more complete adjustment for blood pressure on this association had not been systematically assessed.
Does chronic kidney disease increase the risk of incident stroke independent of blood pressure in adults?
Comparison
Estimated glomerular filtration rate <60 mL/min per 1.73 m 2 vs higher levels
Design
Systematic review and meta-analysis of cohort studies and randomized controlled trials
Authors
Discussion
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Implication
BP adjustment largely nullifies the CKD-stroke link; confirms hypertension confounding and leaves open any independent effect.
Study Design
Type
Meta-Analysis (n=5,611,939)
Multicenter
Yes
Structured PICO
Does chronic kidney disease increase the risk of incident stroke independent of blood pressure in adults?
P
Population
Meta-analysis of 168 studies comprising 5,611,939 adults to evaluate the association between baseline estimated glomerular filtration rate and incident stroke.
E
Exposure
Estimated glomerular filtration rate <60 mL/min per 1.73 m2 (chronic kidney disease)
C
Comparator
Normal or higher estimated glomerular filtration rate
O
Outcome
Incident strokehard clinical
Main Result
Relative Risk: 1.73 (95% CI 1.57–1.9)
p-value: p=<0.001
The apparent independent relationship between chronic kidney disease and stroke risk is largely confounded by long-term prior blood pressure, as more thorough adjustment for hypertension significantly attenuates the association.
Limitations
- Substantial heterogeneity between studies (I2=78.5%)
- Potential confounding by shared association with long-term prior blood pressure
Cite This Study
Kelly et al. (2019) conducted a meta-analysis in Chronic kidney disease (n=5,611,939). Estimated glomerular filtration rate <60 mL/min per 1.73 m2 vs. Higher estimated glomerular filtration rate was evaluated on Incident stroke (RR 1.73, 95% CI 1.57-1.90, p=<0.001). Chronic kidney disease (eGFR <60) was associated with increased stroke risk (RR 1.73; 95% CI 1.57-1.90), but this was attenuated after adjustment for multiple blood pressure measurements (RR 1.10).