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July 25, 2006; 67 (2) Editorials

Reno-cerebrovascular disease?

The incognito kidney in cognition and stroke

Rebeca D. Monk, David A. Bennett
First published July 24, 2006, DOI: https://doi.org/10.1212/01.wnl.0000231530.04240.f8
Rebeca D. Monk
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David A. Bennett
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Reno-cerebrovascular disease?
The incognito kidney in cognition and stroke
Rebeca D. Monk, David A. Bennett
Neurology Jul 2006, 67 (2) 196-198; DOI: 10.1212/01.wnl.0000231530.04240.f8

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Chronic kidney disease (CKD) is a growing national concern and global public health problem, which affects nearly 20 million people in the United States alone.1 Two articles in this issue of Neurology consider neurologic complications of CKD.2,3 A number of well-known risk factors for stroke and TIA are also associated with risk of CKD. For example, diabetes mellitus and hypertension are the primary causes of kidney failure in approximately 75% of dialysis patients. In fact, by the time dialysis is initiated, more than 70% of patients with CKD have four to six comorbidities. Besides diabetes and hypertension, dialysis patients often have congestive heart failure, atherosclerotic heart disease, and TIA or stroke.4 In addition to vascular risk factors and diseases, patients with CKD are predisposed to oxidative stress, inflammation, elevated homocysteine levels, anemia, and vascular calcification,5,6 all of which have been associated with impaired neurologic function. Thus, it is not surprising that patients with CKD have a variety of neurologic conditions including cerebrovascular disease and cognitive impairment. However, it is becoming increasingly evident that impaired kidney function may confer a significant additional risk for impaired neurologic function and death separate from the vascular risk factors associated with the development of kidney disease.5,7–10

A recent review of large dialysis and hospital discharge databases revealed that dialysis patients are at increased risk of ischemic stroke ranging from about a fourfold increase in African American men to about a 10-fold increase in white women relative to the general population.11 Data conflict as to whether CKD increases the risk of stroke among predialysis patients. In a study combining four large community-based data sets, including the Framingham Heart Study and the Atherosclerosis Risk in Communities (ARIC) Study, with a combined sample size in excess of 20,000, predialysis patients did not …

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