Kidney disease and stroke: epidemiology and potential mechanisms of susceptibility.

Patients with Chronic Kidney Disease (CKD) have an increased risk of both ischemic and haemorrhagic stroke compared to the general population. Both acute and chronic kidney impairment are independently associated with poor outcome after the onset of a stroke, after adjustment on confounders. End-stage kidney disease (ESKD) is associated with a 7- and 9-fold increased incidence of both ischemic and haemorrhagic strokes, respectively, poorer neurological outcome and a 3-fold higher mortality. Acute kidney injury (AKI) occurs in 12% of patients with stroke and is associated with a 4-fold increased mortality and unfavourable functional outcome. CKD patients seem to have less access to revascularisation techniques like thrombolysis and thrombectomy despite their worst prognosis. Even if CKD patients could benefit from these specific treatments in acute ischemic stroke, their prognostic remain poorer. After thrombolysis, CKD is associated with a 40% increased risk of intracerebral haemorrhage (ICH), a 20% increase in mortality and a poorer functional neurological outcome. After thrombectomy, CKD is not associated with ICH but still associated with an increased mortality, and AKI with unfavourable outcome and mortality. The beneficial impact of gliflozins on the prevention of stroke is still uncertain. Non-traditional risk factors of stroke, like uremic toxins, can lead to chronic cerebrovascular disease predisposing to stroke in CKD, notably through an increase in the blood-brain barrier permeability and impaired coagulation and thrombosis mechanisms. Preclinical and clinical studies are needed to specifically assess the impact of these non-traditional risk factors on the stroke incidence and outcomes, aiming to optimize and identify potential therapeutic targets.