Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK.
Int J Stroke. 2021 Oct;16(7):758-770. doi: 10.1177/1747493020975250. Epub 2020 Nov 27.
With both an aging population and greater post-stroke survival, multimorbidity is a growing healthcare challenge, affecting over 40% of stroke patients, and rising rapidly and predictably with increasing age. Commonly defined as the co-occurrence of two or more chronic conditions, multimorbidity burden is a strong adverse prognostic factor, associated with greater short- and long-term stroke mortality, worse rehabilitation outcomes, and reduced use of secondary prevention. Chronic kidney disease can be considered as the archetypal comorbidity, being age-dependent and also affecting about 40% of stroke patients. Chronic kidney disease and stroke share very similar traditional cardiovascular risk factor profiles such as hypertension and diabetes, though novel chronic kidney disease-specific risk factors such as inflammation and oxidative stress have also been proposed. Using chronic kidney disease as an exemplar condition, we explore the mechanisms of risk in multimorbidity, implications for management, impact on stroke severity, and downstream consequences such as post-stroke cognitive impairment and dementia.
随着人口老龄化和中风后存活率的提高，多种疾病成为了一个日益严峻的医疗保健挑战，影响了超过 40%的中风患者，且随着年龄的增长，其发病率呈快速且可预测的上升趋势。多种疾病通常被定义为两种或多种慢性疾病同时存在，其负担是一个严重的预后不良因素，与更高的短期和长期中风死亡率、更差的康复结果以及二级预防的使用率降低相关。慢性肾脏病可以被视为典型的合并症，它与年龄相关，也影响了大约 40%的中风患者。慢性肾脏病和中风具有非常相似的传统心血管危险因素谱，如高血压和糖尿病，但也提出了一些新的慢性肾脏病特有的危险因素，如炎症和氧化应激。本文以慢性肾脏病为例，探讨了多种疾病中的风险机制、对管理的影响、对中风严重程度的影响，以及中风后认知障碍和痴呆等下游后果。
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