Associations of chronic kidney disease with recurrent stroke in patients with intracerebral haemorrhage

BACKGROUND: Chronic kidney disease (CKD) is a frequent comorbidity of patients with intracerebral haemorrhage (ICH) and is associated with more severe cerebral small vessel disease. Whether CKD is associated with recurrent stroke after ICH is unknown. PATIENTS AND METHODS: We conducted a retrospective cohort study of 2 comprehensive stroke centres, collecting data from consecutive patients with ICH. Patients with secondary causes of ICH were excluded. We defined CKD according to Kidney Disease: Improving Global Outcomes definitions, namely 2 measurements of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 ≥ 3 months apart. The primary outcome was time to any stroke (recurrent ICH or ischaemic stroke), investigated using Cox regression adjusted for age, sex and comorbidities. Outcomes were confirmed by neuroimaging review. RESULTS: A total of 1062 patients (mean age 68 ± 14 years, 45% female) with ICH were included, 239 with CKD. Over a median (IQR) follow-up of 2.3 (0.7-5.0) years, there was a higher rate of any stroke in the CKD group, 8.4 (95% CI, 6.2-11.1) events per 100 person-years vs 4.4 (3.6-5.3) events in the group with normal eGFR (adjusted hazard ratio [aHR] 1.75: 95% CI, 1.23-2.50, P = .002). CKD was also independently associated with both recurrent ICH (aHR 1.81: 95% CI, 1.15-2.85) and ischaemic stroke (aHR 1.78: 95% CI, 1.06-3.01). CONCLUSION: Patients with ICH and CKD are at increased risk of recurrent ICH and ischaemic stroke compared to those with normal eGFR. Further research is needed into this high-risk patient group to identify new prevention treatments.