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Articles
August 8, 2012

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

September 4, 2012 issue
79 (10) 981-987

Abstract

Objective:

The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA.

Methods:

We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.

Results:

Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p ≤ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03–5.92) and IADL impairment (OR 3.86, 95% CI 1.60–9.28).

Conclusions:

Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 79Number 10September 4, 2012
Pages: 981-987
PubMed: 22875090

Publication History

Received: October 14, 2011
Accepted: February 29, 2012
Published online: August 8, 2012
Published in print: September 4, 2012

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Disclosure

M. Kurella Tamura receives grant support from NIH and has served on a Scientific Advisory Board for Amgen. J. Biada Meyer reports no disclosures. A. Saxena has received honoraria from Wake Forest University. J.W.T. Huh reports no disclosures. V. Wadley receives grant support from Genzyme Therapeutics and NIH and has served on a Scientific Advisory Board for Amgen. B. Schiller is Chief Medical Officer of Satellite Healthcare, serves on the Scientific Advisory Boards for Affymax and NxStage, and as a Consultant to Takeda. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

Manjula Kurella Tamura, MD, MPH
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
Disclosure
Scientific Advisory Boards:
1.
Amgen
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. NIH/NIA K23 AG028952 PI 2007-2012 2. NIH/NIDDK R01 DK069406-06 Co-PI 2011-2015 3. Center for Biomedical Imaging at Stanford PI 2011-2012
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jaclyn Biada Meyer, BS
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Anjali B. Saxena, MD
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Wake Forest University Dept of Continuing Medical Education (CME), speaker honoraria and travel funding
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
Wake Forest University Dept of CME
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
J.W. Terri Huh, PhD
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Virginia G. Wadley, PhD
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
Disclosure
Scientific Advisory Boards:
1.
Amgen, Inc. Scientific Advisory Board
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Amgen, Inc., travel expenses and honorarium
Editorial Boards:
1.
Current Gerontology and Geriatrics Research, editoral board, 2010-present, no compensation
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Genzyme Therapeutics, investigator-initiated grant, PI
Research Support, Government Entities:
1.
NIH, NO1 HC48047, Co-I, 1989-2013; NIH, U01 NS51488, Co-I, 2007-2012; NIH, R01 NS061846,Co-I, 2008-2013; NIH, P30 AG022838,Co-I,2009-2014; NIH, HHSN268200900047C, Co-I, 2009–2018; NIH, R01 AG021958, Co-I, 2009–2014; NIH, R01 AG039588, Co-I, 2011-2016; Jefferson County [AL] Office of Senior Citizens Services, PI, 2006–2011; NIH, R01 NS45789, Co-I. 2005-2011; NIH, U01 AG14289, Co-I, 2008-2011; NIH, R01 AG005739, Co-I, 2006–2011
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Brigitte Schiller, MD
From the Division of Nephrology (M.K.T., J.B.M., A.B.S., B.S.), Stanford University School of Medicine, Palo Alto; Geriatric Research and Education Clinical Center (M.K.T., J.W.T.H.), VA Palo Alto Health Care System, Palo Alto; Division of Nephrology (A.B.S.), Santa Clara Valley Medical Center, San Jose, CA; Division of Gerontology (V.G.W.), Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham; and Satellite Health Care (B.S.), San Jose, CA.
Disclosure
Scientific Advisory Boards:
1.
SAB Affymax since 2007; SAB Nxstage since 2009
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Affymax, Takeda (since 2012)
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
CMO of Satellite Healthcare - a not-for profit dialysis provider
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Study funding: Supported by NIH/NIA K23 AG028952 (K. Tamura).
Correspondence & reprint requests to Dr. Tamura: [email protected]

Author Contributions

Dr. Kurella Tamura designed the study, obtained funding, analyzed the data, and drafted the manuscript. Ms. Biada Meyer acquired the data, supervised the study, and contributed to interpretation of the data and revision of the manuscript content. Dr. Saxena contributed to coordination of the study and interpretation of the data and revision of the manuscript content. Dr. Huh contributed to interpretation of the data and revision of the manuscript content. Dr. Wadley contributed to interpretation of the data and revision of the manuscript content. Dr. Schiller contributed to coordination of the study and interpretation of the data and revision of the manuscript content.

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  3. Chronic Kidney Disease and Cerebrovascular Disease, Stroke, 52, 7, (2021).https://doi.org/10.1161/STROKEAHA.120.029680
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