Outcome of Stroke in Patients Undergoing Hemodialysis

Mattana, Joseph; Effiong, Charles; Gooneratne, Romesh; Singhal, Pravin C.

doi:10.1001/archinte.158.5.537

Cited by 17 publications

(7 citation statements)

References 21 publications

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“…Based on this study, for every 100 dialysis patients who have a stroke, thirty-five of them will die within thirty days, and only fifty-six of the one hundred patients will be able to go home or to an acute rehabilitation facility. While this low “successful recovery” rate is similar to that found in an earlier single-center cohort of prevalent hemodialysis patients followed in New York,27 it is inferior to the 10% adjusted stroke case-fatality rate seen in the Atherosclerosis Risk in Communities (ARIC) cohort28 and the 20% of patients requiring institutional care in the general population 28. This likely reflects the comorbid conditions that our patients on dialysis accumulated before they experienced a stroke.…”

Section: Discussionsupporting

confidence: 67%

Cerebrovascular Disease Incidence, Characteristics, and Outcomes in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study

Sozio

Armstrong

Coresh

et al. 2009

American Journal of Kidney Diseases

166

145

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Background Stroke is the third most common cause of cardiovascular disease death in patients on dialysis; however, characteristics of cerebrovascular disease, including clinical subtypes and subsequent consequences, have not been well described. Study Design Prospective national cohort study, the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. Settings & Participants 1,041 incident dialysis patients treated in 81 clinics, enrolled from 10/95–7/98, followed until 12/31/2004. Predictor Time from dialysis initiation. Outcomes & Measurements Cerebrovascular disease events were defined as non-fatal (hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. Stroke subtypes were classified using standardized criteria from the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system. Incidence of cerebrovascular event subtypes were analyzed using time-to-event analyses accounting for competing risk of death. Clinical outcomes after stroke were abstracted from medical records. Results A total of 165 participants experienced a cerebrovascular event with an overall incidence of 4.9 per 100 person-years. Ischemic stroke was the most common (76% of all 200 events) with cardioembolism subtype accounting for 28% of the 95 abstracted ischemic events. The median time from onset of symptoms to first stroke evaluation was 8.5 hours (25th and 75th percentiles 1, 42 hours), with only 56% of patients successfully escaping death, nursing home, or a skilled nursing facility. Limitations Relatively small sample size limits power to determine risk factors. Conclusions Cerebrovascular disease is common in dialysis patients, is identified late, and carries a significant risk of morbidity and mortality. Stroke etiologic subtypes on dialysis are multifactorial, suggesting risk factors may change the longer one has ESRD. Further studies are needed to address the poor prognosis through prevention, early identification, and treatment.

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Section: Discussionsupporting

confidence: 67%

Cerebrovascular Disease Incidence, Characteristics, and Outcomes in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study

Sozio

Armstrong

Coresh

et al. 2009

American Journal of Kidney Diseases

166

145

View full text Add to dashboard Cite

show abstract

“…In addition, nontradition risk factors, including the uraemic process 8,9 and the dialysis process itself, 10 may predispose patients undergoing dialysis to stroke. Several studies have found that the incidence of stroke in patients with ESRD is much greater than that in the general population 11–18 . However, only few studies have characterized stroke subtypes and existing studies lack consistency.…”

mentioning

confidence: 99%

Haemodialysis and the risk of stroke: A population‐based cohort study in Taiwan, a country of high incidence of end‐stage renal disease

Kuo

Lee

et al. 2012

Nephrology

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“…29,30 In addition, although hemodialysis ameliorates many of the metabolic disturbances of uremia, patients with ESRD have a substantially higher risk for death due to cerebrovascular disease than does the general population. 31,32 In addition to the APACHE II score and history of stroke, we found that postoperative RUO, even at low levels, was an independent predictor of lower 30-day mortality rate in maintenance hemodialysis patients. The OR of 30-day mortality was 4.56 for patients with postoperative anuria.…”

Section: Discussionmentioning

confidence: 73%

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

Lin

Ko³

et al. 2009

American Journal of Critical Care

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BackgroundThe relationship between residual urine output and postoperative survival in maintenance hemodialysis patients is unknown. Objective To explore the relationship between amount of urine before surgery and postoperative mortality and differences between postoperative nonanuria and anuria in maintenance hemodialysis patients. Methods A total of 109 maintenance hemodialysis patients underwent major operations. Anuria was defined as urine output <30 mL in the 8 hours before the first session of postoperative dial ysis. Propensity scores for postoperative anuria were developed. Results Postoperative residual urine output was 159.2 mL/8 h (SD, 115.1) in 33 patients; 76 patients were anuric. Preoperative residual urine output and adequate perioperative blood transfusion were positively related to postoperative urine output. Propensity-adjusted 30-day mortality was associated with postoperative anuria (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.16-17.96; P = .03), prior stroke (OR, 4.46; 95% CI, 1.43-13.89; P = .01) and higher disease severity (OR, 1.10; 95% CI, 1.00-1.21; P = .049) at the first postoperative dialysis. OR of 30-day mortality was 5.38 for nonanuria to anuria vs nonanuria to non anuria (P = .03) and 5.13 for preoperative anuria vs non anuria to nonanuria (P = .01). By Kaplan-Meier analysis, 30-day mortality differed significantly among patients for nonanuria to nonanuria, anuria, and nonanuria to anuria (log rank, P = .045). Conclusion Patients with preoperative nonanuria and postoperative anuria had higher mortality than did patients with no anuria before and after surgery and patients with anuria before surgery. Postoperative residual urine output is an important surrogate marker for disease severity. (American Journal of Critical Care. 2009;18:446-455) The focus of concerns about acute dialysis-related mortality has often been patients' disease severity before surgery.6,7 However, perioperative hemodynamic status and biochemical factors are also related to such patients' mortality, especially in patients with ESRD. Although many factors are related to surgical mortality in patients with ESRD, 8 information on the relationship between RRF and mortality in ESRD patients who undergo a major surgical procedure is limited. In addition, whether perioperative RRF independently is predictive of mortality after major surgery is not known. According to Shemin et al, 5 renal function, as measured by timed urine collections, can have either a beneficial or a protective effect in hemodialysis patients. The role of residual urine output (RUO) in hemodialysis patients is often neglected, and it remains unknown whether the results of survival studies in hemodialysis patients with anuria can be extrapolated to hemodialysis patients who still have RUO after major surgery.Because the amount of urine can be measured accurately in the intensive care unit (ICU), 9 we attempted to gauge RRF by RUO and examined the predictive value of postoperative anuria for ICU mortality among maintenance hemodialys...

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Outcome of Stroke in Patients Undergoing Hemodialysis

Cited by 17 publications

References 21 publications

Cerebrovascular Disease Incidence, Characteristics, and Outcomes in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study

Cerebrovascular Disease Incidence, Characteristics, and Outcomes in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study

Haemodialysis and the risk of stroke: A population‐based cohort study in Taiwan, a country of high incidence of end‐stage renal disease

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

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