Abstract / Summary
Background Chronic kidney disease (CKD) is common among patients with acute ischemic stroke (AIS) and is associated with worse outcomes. Although sex-related differences in stroke are well recognized, it remains unclear whether clinical characteristics associated with sex differ according to CKD status. We characterized sex-associated clinical profiles among patients with AIS with and without documented CKD. Methods We conducted a retrospective analysis of the PRISMA Health Stroke Registry. Baseline characteristics were compared between patients with and without documented CKD in the overall cohort and after stratification by sex. Multivariable logistic regression with backward likelihood-ratio selection was used to identify independent clinical characteristics associated with documented CKD in the overall cohort and with male sex within the CKD and non-CKD subgroups. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Internal stability was assessed using bootstrap resampling. Results Among 5,469 patients with AIS, 447 (8.2%) had documented CKD. Independent characteristics associated with CKD included prosthetic heart valve (OR, 3.73), elevated serum creatinine (OR, 2.79), obesity (OR, 2.51), heart failure (OR, 2.21), hypertension (OR, 2.20), African American race (OR, 2.11), and depression (OR, 1.97). In stratified analyses, associations of male sex with sleep apnea, smoking, and diastolic blood pressure ≥80 mmHg were numerically stronger in the CKD group than in the non-CKD group: sleep apnea, OR 4.62 vs. 2.38; smoking, OR 3.19 vs. 1.31; and diastolic blood pressure ≥80 mmHg, OR 2.58 vs. 1.43. However, formal interaction testing did not demonstrate statistically significant effect modification by CKD status. The sex-association model among patients with CKD demonstrated greater apparent discrimination than the corresponding non-CKD model (AUC, 0.785 vs. 0.630). Conclusion Patients with AIS demonstrated distinct sex-associated clinical profiles according to CKD status. Although several associations were numerically stronger among patients with CKD, formal interaction testing did not establish statistically significant effect modification. These findings characterize clinical heterogeneity among men and women with established AIS and warrant further investigation to determine whether these profiles have implications for treatment or outcomes.