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Whether concomitant CKD modifies long\u2010term ischemic stroke risk in individuals with SCT is uncertain. We analyzed data from 3602 genotyped black adults (female = 62%, mean baseline age = 54\u2009years) who were followed for a median 26\u2009years by the Atherosclerosis Risk in Communities Study. Ischemic stroke was verified by physician review. Associations between SCT and ischemic stroke were analyzed using repeat\u2010events Cox regression, adjusted for potential confounders. SCT was identified in 236 (7%) participants, who more often had CKD at baseline than noncarriers (18% vs 13%,\n                    <jats:italic>P<\/jats:italic>\n                    = .02). Among those with CKD, elevated factor VII activity was more prevalent with SCT genotype (36% vs 22%;\n                    <jats:italic>P<\/jats:italic>\n                    = .05). From 1987\u20102017, 555 ischemic strokes occurred in 436 individuals. The overall hazard ratio of ischemic stroke associated with SCT was 1.31 (95% CI: 0.95\u20101.80) and was stronger in participants with concomitant CKD (HR = 2.18; 95% CI: 1.16\u20104.12) than those without CKD (HR = 1.09; 95% CI: 0.74\u20101.61);\n                    <jats:italic>P<\/jats:italic>\n                    for interaction = .04. The hazard ratio of composite ischemic stroke and\/or death associated with SCT was 1.20 (95% CI: 1.01\u20101.42) overall, 1.44 (95% CI: 1.002\u20102.07) among those with CKD, and 1.15 (95% CI: 0.94\u20101.39) among those without CKD;\n                    <jats:italic>P<\/jats:italic>\n                    for interaction = .18. The long\u2010term risk of ischemic stroke associated with SCT relative to noncarrier genotype appears to be modified by concomitant CKD.\n                  <\/jats:p>","DOI":"10.1002\/ajh.25615","type":"journal-article","created":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T03:00:13Z","timestamp":1566270013000},"page":"1306-1313","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Thirty\u2010year risk of ischemic stroke in individuals with sickle cell trait and modification by chronic kidney disease: The atherosclerosis risk in communities (ARIC) study"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-5147","authenticated-orcid":false,"given":"Melissa C.","family":"Caughey","sequence":"first","affiliation":[{"name":"Department of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vimal K.","family":"Derebail","sequence":"additional","affiliation":[{"name":"Department of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel S.","family":"Key","sequence":"additional","affiliation":[{"name":"Department of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P.","family":"Reiner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca F.","family":"Gottesman","sequence":"additional","affiliation":[{"name":"Department of Neurology Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhijit V.","family":"Kshirsagar","sequence":"additional","affiliation":[{"name":"Department of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Heiss","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of North Carolina at Chapel Hill  Chapel Hill North 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