Chronic kidney disease is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in patients with chronic kidney disease, accounting for this association. However, factors unique to these patients, such as uremia, oxidative stress, and mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with chronic kidney disease, especially those who are dialysis dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventive and therapeutic interventions for stroke in the general population. In this review, we explore the complexities and challenges of these interventions in the population with renal disease.In high-risk patients with prior vascular disease or some other predisposing condition, antiplatelet therapy has been associated with a 25% relative risk (RR) reduction in nonfatal stroke compared with placebo. 

Despite their proven benefit in the general population, major gaps exist in our understanding of the effects of antiplatelet drugs on thrombosis and bleeding in CKD, particularly in the setting of primary prevention.Intravenous thrombolysis (IVT) has become the standard of care for many patients admitted with acute ischemic stroke with better functional outcomes and survival. However, its use may be more problematic in patients with CKD given their greater bleeding diathesis and preexisting cerebrovascular disease burden. Some studies have reported an increased bleeding risk in IVT-treated patients with advanced CKD compared with patients with normal renal function.

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Regards
Mishita
Jornal co-ordinator
Journal of Clinical & Experimental Nephrology