Stroke, cognition and outcomes for people with chronic kidney disease

Abstract

Chronic kidney disease (CKD) is a major public health problem affecting 10-15% of the adult population. Outcomes of CKD include not only progression to end stage kidney disease (ESKD) but also complications from reduced kidney function and treatments for ESKD, and increased risk of cardiovascular disease. In chapter 1, outcome reporting practices for core outcomes in trials of primary immunosuppression in kidney transplant recipients are described through systematic review of randomised trial data, with an emphasis on identifying potential sources of reporting bias. Despite people with CKD being at increased risk of stroke, the magnitude of stroke risk, the effect of traditional and novel risk factors for stroke, and prognosis following stroke in CKD and ESKD are unclear. Chapter 2 uses systematic review of randomised trial and observational study data to establish estimates of stroke risk in people with CKD. Chapters 3 and 4 use cohort data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), the New South Wales Admitted Patient Data Collection and the New South Wales Registry of Births Deaths and Marriages to establish estimates of stroke risk and identify risk factors for stroke in people with ESKD. Chapter 5 uses data from a cohort study of people presenting to hospital with an ischaemic stroke followed-up at 90 days to establish how CKD affects prognosis following a stroke. People with CKD and ESKD have a 65-80% greater risk of having cognitive impairment than age-matched people without kidney disease, but whether cognition improves after a kidney transplant is relatively unclear. The final chapter uses systematic review of observational study data to examine the effect of kidney transplantation on cognitive function. The overarching purpose of each study was to underpin the theme of the thesis: improving outcomes for people with CKD and ESKD.