For a prospective cohort study, researchers sought to investigate stroke incidence and subtypes by chronic kidney disease (CKD) stage, investigate whether CKD patients with or without proteinuria have a high risk of stroke independent of traditional cardiovascular risk factors, and determine precise estimates of stroke risk by CKD stage while accounting for competing for mortality risk.

Participants were 2,023 individuals recruited in the Sado Project for Total Health between June 2008 and December 2016 (55% men; mean age, 69 years), 52% of whom had CKD (stage 1-2, 10%; G3a, 48%; G3b, 17%; G4-5, 11%, and G5D, 14%).

About 157 people had strokes over a five-year median follow-up of 5.7 years, whereas 448 died without a stroke. Most stroke cases among non-dialysis-dependent CKD patients were ischemic, while the relative incidence of ischaemic stroke was similar to that of intracerebral hemorrhage among dialysis-dependent CKD people. After correction, stage 1-2 (HR, 2.97; 95% CI, 1.60-5.51) and stage G3-5 persons with proteinuria (HR, 2.50; 95% CI, 1.56-4.02), but not stage G3-5 participants without proteinuria (HR, 0.64; 95% CI, 0.38-1.08), had a greater stroke risk than non-CKD participants. The link was weaker but still significant in competing for risk analyses.

Despite differences in stroke subtype distribution, CKD individuals with proteinuria and those with CKD stage 5D had a 2- and 4-fold greater risk of stroke, respectively, than non-CKD participants, even after controlling for competing mortality risk and conventional risk variables.