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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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