Hsi-Hao Wang1, Shih-Yuan Hung2, Junne-Ming Sung3, Kuan-Yu Hung4, Jung-Der Wang5. 1. Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan. 2. Division of Nephrology, Department of Internal Medicine, E-Da Hospital/Department of Health Management, I-Shou University, Kaohsiung, Taiwan. 3. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. 4. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 5. Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: jdwang121@gmail.com.
Abstract
BACKGROUND: Patients undergoing maintenance dialysis are at increased risk of stroke. STUDY DESIGN: We performed a nationwide retrospective cohort study to determine the risks for ischemic stroke and hemorrhagic stroke among incident hemodialysis (HD) and peritoneal dialysis (PD) patients in comparison to a reference group in Taiwan. SETTING & PARTICIPANTS: Data for 74,192 HD patients, 5,974 PD patients, and 669,773 nondialysis individuals who were older than 18 years and had no history of stroke or cancer were retrieved from the National Health Insurance Research Database for 1998-2009. PREDICTORS: Patient demographics, comorbid conditions. OUTCOME: First hospitalization for stroke, defined as a diagnosis at discharge (either primary or 1 of 4 secondary diagnoses) of ischemic or hemorrhagic stroke using International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS: HD and PD patients had higher incidences of hospitalized ischemic stroke (102.6 and 100.1/10,000 person-years) and hemorrhagic stroke (74.7 and 59.4/10,000 person-years) in comparison to the age- and sex-matched reference cohort (42.4 and 13.0/10,000 person-years, respectively). In addition to HD and PD therapy, older age, male sex, diabetes, and hypertension were found to be independent risk factors for both ischemic and hemorrhagic strokes. Using the HD group as the comparison group, we found that PD patients had a lower risk of hemorrhagic stroke (HR, 0.75; 95% CI, 0.58-0.96), and there was no significant difference in risks of ischemic stroke between PD and HD patients after adjusting for all potential confounders and competing risk of death, and matched by propensity scores. LIMITATIONS: This was a retrospective study, and some important variables were not available. CONCLUSIONS: Patients undergoing dialysis are at elevated risk of stroke. Patients undergoing PD appear to be less likely to develop hemorrhagic stroke than those undergoing HD. Comprehensive control of hypertension and diabetes is necessary when delivering dialysis treatment.
BACKGROUND:Patients undergoing maintenance dialysis are at increased risk of stroke. STUDY DESIGN: We performed a nationwide retrospective cohort study to determine the risks for ischemic stroke and hemorrhagic stroke among incident hemodialysis (HD) and peritoneal dialysis (PD) patients in comparison to a reference group in Taiwan. SETTING & PARTICIPANTS: Data for 74,192 HDpatients, 5,974 PDpatients, and 669,773 nondialysis individuals who were older than 18 years and had no history of stroke or cancer were retrieved from the National Health Insurance Research Database for 1998-2009. PREDICTORS: Patient demographics, comorbid conditions. OUTCOME: First hospitalization for stroke, defined as a diagnosis at discharge (either primary or 1 of 4 secondary diagnoses) of ischemic or hemorrhagic stroke using International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS:HD and PDpatients had higher incidences of hospitalized ischemic stroke (102.6 and 100.1/10,000 person-years) and hemorrhagic stroke (74.7 and 59.4/10,000 person-years) in comparison to the age- and sex-matched reference cohort (42.4 and 13.0/10,000 person-years, respectively). In addition to HD and PD therapy, older age, male sex, diabetes, and hypertension were found to be independent risk factors for both ischemic and hemorrhagic strokes. Using the HD group as the comparison group, we found that PDpatients had a lower risk of hemorrhagic stroke (HR, 0.75; 95% CI, 0.58-0.96), and there was no significant difference in risks of ischemic stroke between PD and HDpatients after adjusting for all potential confounders and competing risk of death, and matched by propensity scores. LIMITATIONS: This was a retrospective study, and some important variables were not available. CONCLUSIONS:Patients undergoing dialysis are at elevated risk of stroke. Patients undergoing PD appear to be less likely to develop hemorrhagic stroke than those undergoing HD. Comprehensive control of hypertension and diabetes is necessary when delivering dialysis treatment.
Authors: Xiao Lu Jiang; Ji Qiu Wen; Long Jiang Zhang; Gang Zheng; Xue Li; Zhe Zhang; Ya Liu; Li Juan Zheng; Long Wu; Hui Juan Chen; Xiang Kong; Song Luo; Guang Ming Lu; Xue Man Ji; Zong Jun Zhang Journal: Metab Brain Dis Date: 2016-05-11 Impact factor: 3.584
Authors: Angela Yee Moon Wang; K Scott Brimble; Gillian Brunier; Stephen G Holt; Vivekanand Jha; David W Johnson; Shin-Wook Kang; Jeroen P Kooman; Mark Lambie; Chris McIntyre; Rajnish Mehrotra; Roberto Pecoits-Filho Journal: Perit Dial Int Date: 2015 Jul-Aug Impact factor: 1.756