Rajesh Kruthajn, Spring Kevin J, Smokovski Ivica, Upmanyue Vedant, Mehndiratta Man Mohan, Strippoli Giovanni F M, Beran Roy G, Bhaskar Sonu M M
Global Health Neurology Lab, Sydney, NSW, 2150, Australia.
UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2F170, Australia.
Clin Exp Nephrol. 2025 Feb;29(2):149-172. doi: 10.1007/s10157-024-02556-w. Epub 2024 Dec 3.
Chronic kidney disease (CKD) significantly increases stroke risk and severity, posing challenges in both acute management and long-term outcomes. CKD contributes to cerebrovascular pathology through systemic inflammation, oxidative stress, endothelial dysfunction, vascular calcification, impaired cerebral autoregulation, and a prothrombotic state, all of which exacerbate stroke risk and outcomes.
This review synthesizes evidence from peer-reviewed literature to elucidate the pathophysiological mechanisms linking CKD and stroke. It evaluates the efficacy and safety of acute reperfusion therapies-intravenous thrombolysis and endovascular thrombectomy-in CKD patients with acute ischemic stroke. Considerations, such as renal function, drug dosage adjustments, and the risk of contrast-induced nephropathy, are critically analyzed. Evidence-based recommendations and research priorities are drawn from an analysis of current practices and existing knowledge gaps.
CKD influences stroke outcomes through systemic and local pathophysiological changes, necessitating tailored therapeutic approaches. Reperfusion therapies are effective in CKD patients but require careful monitoring of renal function to mitigate risks, such as contrast-induced nephropathy and thrombolytic complications. The bidirectional relationship between stroke and CKD highlights the need for integrated management strategies to address both conditions. Early detection and optimized management of CKD significantly reduce stroke-related morbidity and mortality.
Optimizing stroke care in CKD patients requires a comprehensive understanding of their pathophysiology and clinical management challenges. This article provides evidence-based recommendations, emphasizing individualized treatment decisions and coordinated care. It underscores the importance of integrating renal considerations into stroke treatment protocols and highlights the need for future research to refine therapeutic strategies, address knowledge gaps, and consider tailored interventions to improve outcomes and quality of life for this high-risk population.
慢性肾脏病（CKD）显著增加中风风险和严重程度，在急性管理和长期预后方面都带来挑战。CKD 通过全身炎症、氧化应激、内皮功能障碍、血管钙化、脑自动调节受损和血栓前状态导致脑血管病变，所有这些都会加剧中风风险和预后。
本综述综合了同行评审文献中的证据，以阐明连接CKD和中风的病理生理机制。它评估了急性再灌注治疗（静脉溶栓和血管内血栓切除术）在CKD合并急性缺血性中风患者中的疗效和安全性。对诸如肾功能、药物剂量调整以及造影剂诱导的肾病风险等因素进行了批判性分析。基于对当前实践和现有知识差距的分析得出了循证建议和研究重点。
CKD 通过全身和局部病理生理变化影响中风预后，需要采取针对性的治疗方法。再灌注治疗对CKD患者有效，但需要仔细监测肾功能以降低风险，如造影剂诱导的肾病和溶栓并发症。中风与CKD之间的双向关系凸显了需要综合管理策略来应对这两种情况。CKD的早期检测和优化管理可显著降低中风相关的发病率和死亡率。
优化CKD患者的中风护理需要全面了解其病理生理学和临床管理挑战。本文提供了循证建议，强调个性化治疗决策和协调护理。它强调了将肾脏因素纳入中风治疗方案的重要性，并突出了未来研究的必要性，以完善治疗策略、填补知识空白并考虑针对性干预措施，以改善这一高危人群的预后和生活质量。
