Ching-Yao Cheng1, Hue-Yu Wang2, Wen-Shyong Liou1, Ming-Ju Wu3, Chia-Hung Kao4. 1. Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan; School of Pharmacy, China Medical University, Taichung, Taiwan. 2. Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan. 3. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan. Electronic address: wmj530@gmail.com. 4. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan. Electronic address: kao4937b@gmail.com.
Abstract
BACKGROUND: Several comparison studies have suggested that kidney transplant (KT) could reduce stroke risk in patients with end-stage renal disease (ESRD). To avoid the selection criteria bias of using dialysis patients as control groups, we compared the risk of stroke between KT recipients and comparable propensity score-matched dialysis patients. METHODS: We used Taiwan's National Health Insurance Research Database to identify patients with newly diagnosed ESRD between 2000 and 2009. We separated them into 2 groups: a KT group and a non-KT dialysis-only group. To evaluate the stroke outcome, we compared each patient with KT to a patient on dialysis without KT using propensity score matching. RESULTS: In total, 2735 KT recipients and 10,940 propensity score-matched dialysis patients were identified. The incidence rates of overall stroke were 9.1 and 23.4 per 1000 person-years in KT recipients and non-KT dialysis patients. Compared with the propensity score-matched dialysis patients, the patients who received KT exhibited significantly lower overall stroke risk, hemorrhagic stroke, and ischemic stroke, the adjusted hazard ratios were 0.37 (95% CI, 0.31-0.45), 0.19 (95% CI, 0.12-0.29), and 0.46 (95% CI, 0.37-0.56), respectively (all P < .001). CONCLUSIONS: Through a propensity score-matched cohort, this study confirms that KT is associated with a reduced risk of stroke more than dialysis alone in patients with newly diagnosed ESRD.
BACKGROUND: Several comparison studies have suggested that kidney transplant (KT) could reduce stroke risk in patients with end-stage renal disease (ESRD). To avoid the selection criteria bias of using dialysis patients as control groups, we compared the risk of stroke between KT recipients and comparable propensity score-matched dialysis patients. METHODS: We used Taiwan's National Health Insurance Research Database to identify patients with newly diagnosed ESRD between 2000 and 2009. We separated them into 2 groups: a KT group and a non-KT dialysis-only group. To evaluate the stroke outcome, we compared each patient with KT to a patient on dialysis without KT using propensity score matching. RESULTS: In total, 2735 KT recipients and 10,940 propensity score-matched dialysis patients were identified. The incidence rates of overall stroke were 9.1 and 23.4 per 1000 person-years in KT recipients and non-KT dialysis patients. Compared with the propensity score-matched dialysis patients, the patients who received KT exhibited significantly lower overall stroke risk, hemorrhagic stroke, and ischemic stroke, the adjusted hazard ratios were 0.37 (95% CI, 0.31-0.45), 0.19 (95% CI, 0.12-0.29), and 0.46 (95% CI, 0.37-0.56), respectively (all P < .001). CONCLUSIONS: Through a propensity score-matched cohort, this study confirms that KT is associated with a reduced risk of stroke more than dialysis alone in patients with newly diagnosed ESRD.