Renal Continuum and Blood Proinflammatory Status in Older Patients after Cerebrovascular Accidents

Introduction. The renal continuum is a pressing issue in clinical practice, and its components – acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD) – are highly prevalent in elderly patients after stroke. Renal dysfunction and cerebrovascular pathology mutually exacerbate each other’s course, increasing the risk of adverse outcomes. 
Objective: to assess the prevalence of renal continuum components in elderly patients after acute cerebrovascular accidents.
Materials and methods. This prospective cohort study included 120 patients, 53,3% of whom were men and 46,7% women, with an average age of 68.2 ± 3.8 years, with a history of strokes of various phenotypes less than 6 months old. The data were described using modern statistical analysis methods; differences were considered significant at p < 0.05.
Results. The obtained data show that in the study group of patients, 36.7% had AKI, 25.8% had AKD, and more than half (56.7%) suffered from CKD. Numerous studies in the literature confirm the high frequency of AKI and CKD in patients with acute cerebrovascular accident, while AKD has been very little studied. The results of our study are consistent with existing scientific data.
Conclusion. Among older patients, components of the renal continuum are significantly more common and require increased attention and up-to-date assessment to modify therapy and improve prognosis.

For citation: Mihaleva MM, Efremova EV, Shutov AM, Al Ali A, Gnoevykh VV. Renal continuum and blood proinflammatory status in older patients after cerebrovascular accidents. Therapy (Moscow). 2026;12(5S):39–43. 
https://doi.org/10.18565/therapy.2026.5-s5.39-43

INTRODUCTION

The renal continuum is a contemporary framework describing the progression from increased risk of kidney disease through kidney damage and kidney failure to death [1, 2]. It encompasses three closely related clinical entities: acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD) [1–3]. AKI and CKD are associated with adverse outcomes in patients with comorbid conditions and contribute substantially to the overall burden of disease. AKI frequently occurs in critically ill patients, including those with acute myocardial infarction or stroke, with reported incidence rates ranging from 19.2% to 51.3% [3, 4]. AKI is also associated with an increased risk of adverse outcomes and subsequent cardiovascular events [4–6]. CKD is an important component of multimorbidity and is associated with an unfavorable cardiovascular prognosis [7–9]. AKD describes acute or subacute kidney damage and/or loss of kidney function lasting between 7 and 90 days. Despite the availability of consensus definitions and staging criteria, AKD remains underrecognized in clinical practice, partly because of diagnostic challenges and limited implementation of these criteria, and therefore warrants further investigation [1, 10]. Evidence also indicates a bidirectional association between CKD and cardiovascular disease, including cerebrovascular disease [7, 9].

CKD is highly prevalent among older adults (aged ≥60 years), with estimates ranging from 16% to 58% in different studies [7, 8]. This high prevalence is associated with several factors, including age-related nephron loss (glomerulosclerosis) and reduced filtration function, a high burden of comorbidity – particularly hypertension, diabetes, and heart failure – and the need to use multiple medications (polypharmacy) [7, 9]. Moreover, age itself is an independent risk factor for cardiovascular events and adverse outcomes [7, 8]. Older patients with a history of cerebrovascular accident (CVA) have a higher prevalence of renal dysfunction than those without a history of CVA [12, 13]. The concept of the “kidney–brain” axis, illustrated schematically in Figure 1, reflects the close relationship between these organs and the reciprocal effects of kidney and cerebrovascular disease [14]. On the one hand, patients who have had a CVA are at higher risk of developing renal dysfunction; on the other hand, impaired kidney function is associated with a higher incidence of ischemic, hemorrhagic, and mixed stroke [4, 12, 14].

AKI and AKD often lead to the development or progression of CKD. When these conditions occur in patients with pre-existing CKD, they form specific clinical phenotypes (AKI on CKD and AKD on CKD), worsen the prognosis, accelerate progression to end-stage CKD, and increase the need for kidney replacement therapy (KRT) [1]. Figure 2 illustrates the course of kidney changes and the corresponding clinical phenotypes.

Although routine CKD screening in the general population is not universally recommended because of concerns about overdiagnosis [2, 7], older patients with a history of CVA are at very high cardiovascular and renal risk and therefore warrant particular attention. In this group, timely detection of AKI, AKD, and CKD, together with their clinical phenotypes, is important for determining prognosis and subsequent management. Particular attention should be paid to the detection of AKD, a transitional state in the progression from AKI to CKD [1, 2].

The aim of this study was to assess the prevalence of renal continuum components in older patients who had experienced CVAs.

METHODS

The study included 120 older adults (mean age 68.2 ± 3.8 years; 64...

M.M. Mihaleva, E.V. Efremova, A.M. Shutov, A. Al’-Ali, V.V. Gnoevyh