Mark Findlay1,2, Rachael MacIsaac1, Mary Joan MacLeod3,4, Wendy Metcalfe5,6, Jamie P Traynor2,6, Jesse Dawson1,2, Patrick B Mark1,2. 1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 2. The Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK. 3. Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK. 4. Scottish Stroke Care Audit, ISD, Edinburgh, UK. 5. Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK. 6. Scottish Renal Registry, ISD, Glasgow, UK.
Abstract
Background: The risk of stroke in end-stage renal disease (ESRD) on renal replacement therapy (RRT) is up to 10-fold greater than the general population. However, whether this increased risk differs by RRT modality is unclear. Methods: We used data contained in the Scottish Renal Registry and the Scottish Stroke Care Audit to identify stroke in all adult patients who commenced RRT for ESRD from 2005 to 2013. Incidence rate was calculated and regression analyses were performed to identify variables associated with stroke. We explored the effect of RRT modality at initiation and cumulative dialysis exposure by time-dependent regression analysis, using transplant recipients as the reference group. Results: A total of 4957 patients commenced RRT for ESRD. Median age was 64.5 years, 41.5% were female and 277 patients suffered a stroke (incidence rate was 18.6/1000 patient-years). Patients who had stroke were older, had higher blood pressure and were more likely to be female and have diabetes. On multivariable regression older age, female sex, diabetes and higher serum phosphate were associated with risk of stroke. RRT modality at initiation was not. On time-dependent analysis, haemodialysis (HD) exposure was independently associated with increased risk of stroke. Conclusions: In patients with ESRD who initiate RRT, HD use independently increases risk of stroke compared with transplantation. Use of peritoneal dialysis did not increase risk on adjusted analysis.
Background: The risk of stroke in end-stage renal disease (ESRD) on renal replacement therapy (RRT) is up to 10-fold greater than the general population. However, whether this increased risk differs by RRT modality is unclear. Methods: We used data contained in the Scottish Renal Registry and the Scottish Stroke Care Audit to identify stroke in all adult patients who commenced RRT for ESRD from 2005 to 2013. Incidence rate was calculated and regression analyses were performed to identify variables associated with stroke. We explored the effect of RRT modality at initiation and cumulative dialysis exposure by time-dependent regression analysis, using transplant recipients as the reference group. Results: A total of 4957 patients commenced RRT for ESRD. Median age was 64.5 years, 41.5% were female and 277 patients suffered a stroke (incidence rate was 18.6/1000 patient-years). Patients who had stroke were older, had higher blood pressure and were more likely to be female and have diabetes. On multivariable regression older age, female sex, diabetes and higher serum phosphate were associated with risk of stroke. RRT modality at initiation was not. On time-dependent analysis, haemodialysis (HD) exposure was independently associated with increased risk of stroke. Conclusions: In patients with ESRD who initiate RRT, HD use independently increases risk of stroke compared with transplantation. Use of peritoneal dialysis did not increase risk on adjusted analysis.
Authors: Mark Duncan Findlay; Jesse Dawson; David Alexander Dickie; Kirsten P Forbes; Deborah McGlynn; Terry Quinn; Patrick B Mark Journal: J Am Soc Nephrol Date: 2018-12-07 Impact factor: 10.121
Authors: Patrick B Mark; Pardeep S Jhund; Matthew R Walters; Mark C Petrie; Albert Power; Claire White; Michele Robertson; Eugene Connolly; Stefan D Anker; Sunil Bhandari; Kenneth Farrington; Philip A Kalra; Charles R V Tomson; David C Wheeler; Christopher G Winearls; John J V McMurray; Iain C Macdougall; Ian Ford Journal: Kidney360 Date: 2021-09-16