Stroke risk factors in patients with end-stage kidney disease: current status of the problem

Abstract

Chronic kidney disease and its complications are one of the leading causes of morbidity, disability and mortality in the world population, due to both the widespread prevalence of arterial hypertension, diabetes mellitus and coronary heart disease, and the increase in life expectancy. In the terminal stage of chronic kidney disease, mortality from cardiovascular events increases significantly. This review examines the most common risk factors for stroke in end-stage kidney disease. The role of arterial hypertension, diabetes mellitus, chronic heart failure is discussed, taking into account common risk factors, hyperactivation of the renin-angiotensin-aldosterone system, the development of oxidative stress, volume overload with an increase in the size of the left atrium and a subsequent increase in the risk of thrombosis and stroke in patients with end-stage kidney disease on programmed hemodialysis. In addition, data are presented in the study of the contribution of bone mineral disorders to the occurrence of cerebral complications in this category of patients. Timely diagnosis of cardiovascular diseases and secondary prevention of stroke, including adequate antihypertensive, hypoglycemic therapy and correction of heart failure with blockers of the renin-angiotensin-aldosterone system, as well as the elimination of bone mineral disorders are currently a very popular approach to improving the quality of life and increased survival in the discussed category of patients. Understanding the pathogenetic mechanism of stroke in patients with end-stage kidney disease on programmed hemodialysis, with the study of risk factors in the development of an acute cerebrovascular accident, will help to develop a strategy for their management.