Tsang-Shan Chen1, Chao-Hung Chen2, Chien-An Chen3,4, Li-Ping Chou5,6, Chi-Chu Liu7,8. 1. Department of Neurology, Tainan Sinlau Hospital, Tainan, Taiwan. 2. Department of Internal Medicine, Tainan Sinlau Hospital, Tainan, Taiwan. 3. Department of Nephrology, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan. chen.chouml@msa.hinet.net. 4. Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan. chen.chouml@msa.hinet.net. 5. Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan. 6. Department of Cardiology, Tainan Sinlau Hospital, Tainan, Taiwan. 7. Department of Anesthesia, Tainan Sinlau Hospital, Tainan, Taiwan. 8. Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.
Abstract
BACKGROUND: Hemodialysis patients have a high incidence of ischemic stroke. However, the association between serum phosphate levels and ischemic stroke is controversial among hemodialysis patients. The present study is used to evaluate whether serum phosphate levels are associated with ischemic stroke among patients undergoing hemodialysis. METHODS: A total of 84 hemodialysis patients were followed up for 8 years. Data collection included chart reviews and assessments of laboratory records. The ischemic stroke diagnosis was made on the basis of history, physical examination and neuroimaging (computed tomography and/or magnetic resonance imaging) by neurologists. Cox proportional hazard regression models were used to analyze the data. RESULTS: During the follow-up period, 29 patients experienced ischemic stroke. According to Cox proportional hazard regression analysis, the risk of ischemic stroke decreased by 45.5% for each 1-mg/dL increase in averaged serum phosphate (HR 0.545, p = 0.011). The risk of ischemic stroke increased by 4.3% for each 1-year increase in age (HR 1.043, p = 0.018). The risk of ischemic stroke increased by 1.1% increase for each 103/μL increase in averaged blood platelet (HR 1.011, p = 0.009). The risk of ischemic stroke in patients with averaged serum phosphate < 4.5 mg/dL increased 3.40-fold more than patients with averaged serum phosphate ≥ 4.5 mg/dL (HR 3.400, p = 0.025). CONCLUSIONS: Low serum phosphate is a risk factor for developing ischemic stroke in hemodialysis patients. The results suggest that managing serum phosphate ≥ 4.5 mg/dL among hemodialysis patients may reduce the risk of ischemic stroke.
BACKGROUND: Hemodialysis patients have a high incidence of ischemic stroke. However, the association between serum phosphate levels and ischemic stroke is controversial among hemodialysis patients. The present study is used to evaluate whether serum phosphate levels are associated with ischemic stroke among patients undergoing hemodialysis. METHODS: A total of 84 hemodialysis patients were followed up for 8 years. Data collection included chart reviews and assessments of laboratory records. The ischemic stroke diagnosis was made on the basis of history, physical examination and neuroimaging (computed tomography and/or magnetic resonance imaging) by neurologists. Cox proportional hazard regression models were used to analyze the data. RESULTS: During the follow-up period, 29 patients experienced ischemic stroke. According to Cox proportional hazard regression analysis, the risk of ischemic stroke decreased by 45.5% for each 1-mg/dL increase in averaged serum phosphate (HR 0.545, p = 0.011). The risk of ischemic stroke increased by 4.3% for each 1-year increase in age (HR 1.043, p = 0.018). The risk of ischemic stroke increased by 1.1% increase for each 103/μL increase in averaged blood platelet (HR 1.011, p = 0.009). The risk of ischemic stroke in patients with averaged serum phosphate < 4.5 mg/dL increased 3.40-fold more than patients with averaged serum phosphate ≥ 4.5 mg/dL (HR 3.400, p = 0.025). CONCLUSIONS: Low serum phosphate is a risk factor for developing ischemic stroke in hemodialysis patients. The results suggest that managing serum phosphate ≥ 4.5 mg/dL among hemodialysis patients may reduce the risk of ischemic stroke.
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