Risk factors of ischemic stroke and subsequent outcome in hemodialysis patients

Findlay, M. D., Thomson, P. C., Fulton, R. L., Solbu, M. D., Jardine, A. G. , Patel, R. K., Stevens, K. K., Geddes, C. C., Dawson, J. and Mark, P. B. (2015) Risk factors of ischemic stroke and subsequent outcome in hemodialysis patients. Stroke, 46(9), pp. 2477-2481. (doi:10.1161/STROKEAHA.115.009095) (PMID:26230856)

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Abstract

Background and purpose: End stage renal disease (ESRD) requiring hemodialysis (HD) carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge concerning risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke. Methods: All adult patients receiving HD for ESRD from 01/01/2007 to 31/12/2012 were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging and dialysis related variables were assessed and case-fatality determined. Follow-up was until 31/12/2013. Results: 1382 patients were identified (mean age 60.5 years, 58.5% male). The prevalence of AF was 21.2% and 59.4% were incident HD patients. 160 (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident HD patients. Factors associated with stroke on regression analysis were prior stroke, diabetes and age at starting renal replacement therapy. AF was not significantly associated with stroke and warfarin did not affect stroke risk in warfarin treated patients. Fatality was 18.8% at 7, 26.9% at 28 and 56.3% 365 days after stroke.<p></p> Conclusions: Incidence of stroke is high in patients with ESRD on HD with high case-fatality. Incident HD patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving HD.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Patel, Dr Rajan and Mark, Dr Patrick and Solbu, Dr Marit Dahl and Findlay, Dr Mark and Stevens, Dr Kathryn and Dawson, Professor Jesse and Geddes, Dr Colin and Jardine, Professor Alan
Authors: Findlay, M. D., Thomson, P. C., Fulton, R. L., Solbu, M. D., Jardine, A. G., Patel, R. K., Stevens, K. K., Geddes, C. C., Dawson, J., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Stroke
Publisher:Lippincott Williams & Wilkins
ISSN:0039-2499
ISSN (Online):1524-4628

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
691011KRUK Fellowship: Understanding and reducing the risk of cerebrovascular disease in patients with end stage renal disease; from the patient to the populationMark FindlayKidney Research UK (NKRF)TF9/2015RI CARDIOVASCULAR & MEDICAL SCIENCES