Settembre Ottobre 2024 - Articoli originali

Protected: Risk Factors for Stroke in Patients with Nephrotic Syndrome: Experience from Two Centers in Poland

Posted on Wednesday October 2nd, 2024Scarica PDF

Michael Kitlinski

DOI: 10.69097/41-05-2024-10

Michael Kitlinski^1,3, Zbigniew Heleniak MD PhD¹, Aleksander Och¹, Piotr Tylicki¹, Justyna Fercho MD², Tomasz Liberek MD PhD¹, Tomasz Stompór MD PhD⁴, Tomasz Szmuda MD PhD², Alicja Dębska-Ślizień MD PhD¹

1 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
2 Department of Neurosurgery, Medical University of Gdansk, Poland
3 Department of Translational Medicine, Clinical Research Centre, Lund Univeristy, Malmö, Sweden
4 Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-516 Olsztyn, Poland

Corresponing author:
Michael Kitlinski
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk
Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
Tel: +46 722 41 48 41
email: michael.kitlinski@gumed.edu.pl

Abstract

Objective. Patients with nephrotic syndrome (NS) have an increased risk of developing acute ischemic stroke (aIS) and intracranial hemorrhage (ICH). However, the informations on the risk factors for these outcomes are unknown. The aim of this study was therefore to determine the risk factors for stroke among patients with NS.
Methods. A multicentric retrospective cohort of patients who developed aIS or ICH, following a diagnosis of NS between 2010 and 2021 was assembled. NS patients who did not develop stroke at follow-up were assembled as non-matched controls from the same study period. Cox regression yielding a hazard ratio (HR) with a 95% confidence interval was applied to investigate the potential risk factors for stroke among patients with NS. A meta-analysis on the current litterature was also performed.
Results. With a mean follow-up of 6 years, a total of 45 patients with NS were included of which 14 were diagnosed with aIS and 4 with ICH at follow-up. Significant risk factors for stroke in patients with NS were diabetes mellitus (DM) (HR 2.85, 95%CI 1.10-7.49; p-value = 0.03), diabetic nephropathy (HR 2.74, 95% CI 1.06-7.07; p-value = 0.038) smoking (HR 8.29, 95% CI 2.20-31.2; p-value = 0.002), prior arterial thromboembolic events (ATEs) (HR 2.86, 95% CI 1.09-7.53: p-value = 0.03) and age > 55 years old (HR 4.84, 95% CI 1.48-15.8; p-value = 0.009). Administration of low molecular weight heparin (LMWH) (HR 0.88, 95% CI 0.22-3.43; p-value = 0.848) did not affect the risk-estimates for developing stroke in patients with NS. Meta-analysis including 1091 patients revealed prior ATEs, diabetes, hypertension and smoking to be risk factors for ATEs among patients with NS.
Conclusion. In this study we found older age, DM, prior ATEs and smoking to increase the risk of developing stroke in patients with NS, while notably LMWH had no protective effects. Our findings may serve as an aid for physicians in managing and identifying high-risk patients for stroke in this subpopulation.

Keywords: Nephrotic syndrome, Stroke, Thromboembolism, Risk factors