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September 04, 2012; 79 (10) Articles

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

Manjula Kurella Tamura, Jaclyn Biada Meyer, Anjali B. Saxena, J.W. Terri Huh, Virginia G. Wadley, Brigitte Schiller
First published August 8, 2012, DOI: https://doi.org/10.1212/WNL.0b013e31826845e9
Manjula Kurella Tamura
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
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Jaclyn Biada Meyer
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
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Anjali B. Saxena
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
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J.W. Terri Huh
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
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Virginia G. Wadley
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
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Brigitte Schiller
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
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Citation
Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis
Manjula Kurella Tamura, Jaclyn Biada Meyer, Anjali B. Saxena, J.W. Terri Huh, Virginia G. Wadley, Brigitte Schiller
Neurology Sep 2012, 79 (10) 981-987; DOI: 10.1212/WNL.0b013e31826845e9

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Abstract

Objective: The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA.

Methods: We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.

Results: Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p ≤ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03–5.92) and IADL impairment (OR 3.86, 95% CI 1.60–9.28).

Conclusions: Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population.

GLOSSARY

3MS=
Modified Mini-Mental State Examination;
ADL=
activities of daily living;
ARIC=
Atherosclerosis Risk in Communities;
CI=
confidence interval;
CKD=
chronic kidney disease;
COWAT=
Controlled Oral Word Association Test;
ESRD=
end-stage renal disease;
IADL=
instrumental activities of daily living;
OR=
odds ratio;
QVSFS=
Questionnaire for Verifying Stroke Free Status;
RAVLT=
Rey Auditory Verbal Learning Test;
REGARDS=
REasons for Geographic And Racial Disparities in Stroke

Footnotes

  • Study funding: Supported by NIH/NIA K23 AG028952 (K. Tamura).

  • Editorial, page 960

  • Received October 14, 2011.
  • Accepted February 29, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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