Elevated risk of end-stage kidney disease in stroke patients: A population-based observational study

Background: Estimating the incidence of end-stage kidney disease (ESKD) in stroke survivors is important to assess and predict clinical course, improve post-stroke quality of life, and ultimately reduce health burden. Aim: Our objective was to assess the risk of ESKD in patients compared to a matched stroke-free control cohort. Methods: A nationwide retrospective cohort study was conducted in 315,326 stroke subjects and 390,781 matched stroke-free control subjects. Health examination results and claims data were collected from the Korean National Health Insurance Service during 2010–2018. Cox proportional hazard models were used to assess the risk of ESKD in the stroke cohort. Results: During a mean follow-up period of 4.3 years, the incidence of ESKD was 1.83 per 100,000 person-years in the stroke cohort versus 0.57 per 100,000 person-years in the control cohort. The stroke cohort exhibited a significantly higher risk of developing ESKD compared to the matched control, with an adjusted hazard ratio (aHR) of 1.79 (95% confidence interval (CI) = 1.67–1.93). Stroke survivors were associated with a higher risk of developing ESKD, regardless of the severity of disability (aHRs of 1.93, 95% CI = 1.69–2.21 for severe disability; 1.71, 95% CI = 1.41–2.07 for mild disability; and 1.78, 95% CI = 1.65–1.92 for no disability), compared to the matching control cohort. The elevated risk was observed in both hemorrhagic stroke (aHR = 1.96, 95% CI = 1.73–2.23) and ischemic stroke (aHR = 1.75, 95% CI = 1.62–1.89). Conclusions: This study demonstrates that stroke patients have a significantly higher risk of incident ESKD. This highlights the need for heightened clinical awareness and improved monitoring of kidney function in this population.