By: Sami L. Khella
Department of Neurology,
University of Pennsylvania School of Medicine,
Philadelphia, PA.
- Patients with chronic kidney disease are predisposed to stroke, especially as the estimated glomerular filtration rate diseases.
- This update reviews the pathologic mechanisms particular to this stroke population.
- The treatment for primary and secondary prevention of stroke is reviewed with respect to antiplatelet agents, anticoagulants, surgery, and carotid stenting.
- The control of chronic hypertension is particularly important in reducing stroke risk in CDK. In patients with prior stroke from atherosclerosis, antiplatetet agents are most beneficial in reducing secondary stroke risk.
- Those with atrial fibrillation and CDK may benefit from warfarin anticoagulation.
- Statin in CDK for stroke reduction in diabetics receiving dialysis are not useful, and the data are pending for their use in stroke reduction in the general CDK population. In carefully selected cases, carotid endarterectomy can be a treament.
- The data on carotid stenting are conflicting.
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