Risk factors and outcome of stroke in renal transplant recipients

Findlay, M. D. et al. (2016) Risk factors and outcome of stroke in renal transplant recipients. Clinical Transplantation, 30(8), pp. 918-924. (doi:10.1111/ctr.12765) (PMID:27218240)

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Abstract

Stroke incidence is high in end-stage renal disease and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analysed all adult patients with a functioning renal transplant from 01/01/2007 to 31/12/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, imaging and laboratory variables were assessed and case-fatality determined. Follow-up was until 05/12/2013. 956 patients were identified (median age 40.1 years, 59.9% male). Atrial fibrillation prevalence was 9.2% and 38.2% received a transplant during follow-up. 26 (2.7%) experienced a stroke during 4409 patient-years of follow-up (84.6% ischemic). Stroke incidence was 5.96/1000 patient-years. Factors associated with stroke on regression analysis were prior stroke, diabetes, age, systolic hypertension and hemoglobin. Atrial fibrillation was associated with time to stroke (p<0.001).Warfarin did not associate with ischemic stroke risk in those with AF. Fatality was 19.2% at 7, 23.1% at 28 and 42.3% 365 days after stroke. Patients with a functioning renal transplant have a high stroke incidence and case-fatality. Unlike those on hemodialysis, risk factors are similar to the general population. We did not demonstrate benefit from warfarin use in those with AF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Patel, Dr Rajan and Mark, Dr Patrick and Findlay, Dr Mark and Stevens, Dr Kathryn and Rutherford, Dr Elaine and Dawson, Professor Jesse and Macisaac, Dr Rachael and Geddes, Dr Colin and Thomson, Dr Peter and Clancy, Mr Marc and Jardine, Professor Alan
Authors: Findlay, M. D., Thomson, P. C., Macisaac, R., Jardine, A. G., Patel, R. K., Stevens, K. K., Rutherford, E., Clancy, M., Geddes, C. C., Dawson, J., and Mark, P. B.
Subjects:R Medicine > RC Internal medicine
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
Research Group:Renal/Stroke
Journal Name:Clinical Transplantation
Publisher:Wiley
ISSN:0902-0063
ISSN (Online):1399-0012
Published Online:21 June 2016
Copyright Holders:Copyright © 2016 John Wiley and Sons
First Published:First published in Clinical Transplantation 30(8): 918-924
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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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
697391Assessing Cognitive FUnction and MEasuring Cerebral CirculatioN on HaemoDialysis(ACUMEN-HD)Mark FindlayDarlinda's Charity for Renal Disease (DARLINDA)chq no 010608RI CARDIOVASCULAR & MEDICAL SCIENCES