Renal replacement modality and stroke risk in end-stage renal disease—a national registry study

Findlay, M., MacIsaac, R., MacLeod, M. J., Metcalfe, W., Traynor, J. P., Dawson, J. and Mark, P. B. (2018) Renal replacement modality and stroke risk in end-stage renal disease—a national registry study. Nephrology Dialysis Transplantation, 33(9), pp. 1564-1571. (doi: 10.1093/ndt/gfx291) (PMID:29069522)

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.

• Item Type: Articles
• Additional Information: MDF is funded by a Kidney Research UK Training Fellowship and is supported by a grant from Darlinda’s Charity for Renal Research.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Findlay, Dr Mark and Macisaac, Dr Rachael and Mark, Professor Patrick and Traynor, Dr Jamie and Dawson, Professor Jesse
• Authors: Findlay, M., MacIsaac, R., MacLeod, M. J., Metcalfe, W., Traynor, J. P., Dawson, J., and Mark, P. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Nephrology Dialysis Transplantation
• Publisher: Oxford University Press
• ISSN: 0931-0509
• ISSN (Online): 1460-2385
• Published Online: 24 October 2017
• Copyright Holders: Copyright © 2017 The Author
• First Published: First published in Nephrology Dialysis Transplantation 33(9):1564-1571
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.