Prevalence and Impact on Stroke in Patients Receiving Maintenance Hemodialysis versus Peritoneal Dialysis: A Prospective Observational Study

Abstract

BackgroundPatients undergoing maintenance dialysis are at increased risk of stroke, however, less is known about the prevalence and impact on stroke in the patients.MethodsIn this prospective cohort study, 590 patients undergoing hemodialysis (HD; n = 285) or peritoneal dialysis (PD; n = 305) from January 1, 2008 to December 31, 2012 were recruited. Baseline demographic, clinical, and laboratory data were collected. Timeline incidence data were analyzed using a Poisson model. The Cox proportional hazards regression assessed adjusted differences in stroke risk, a multivariate analysis was also performed.Results62 strokes occurred during 1258 total patient-years of follow-up. Stroke occurred at a rate of 49.2/1,000 patient-years with a predominance in HD patients compared with PD patients (74.0 vs. 31.8/1,000 patient-years). The cumulative hazard of developing stroke was significantly higher in HD patients (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.15–3.62; p = 0.046) after adjusting for potential confounders. HD patients had an increased risk of ischemic stroke (HR, 2.62; 95% CI, 1.56–4.58; p = 0.002). The risk of hemorrhagic stroke was not significantly different between PD and HD patients. On multivariate Cox analysis, risk factors of stroke in both HD and PD patients were older age, diabetes, and cardiovascular disease. Other independent risk factors of stroke were lower albumin-corrected calcium in HD patients and higher triglycerides in PD patients.ConclusionsPatients undergoing PD were less likely to develop ischemic stroke than those undergoing HD. Comprehensive control of diabetes, cardiovascular disease, calcium-phosphorus metabolism, and triglyceride levels may be useful preventive strategies for stroke in dialysis patients.

Icodextrin is Associated with a Lower Risk of Stroke in Peritoneal Dialysis Patients

“…Our study revealed the incidence of stroke among PD patients was 23.5/1,000 patient-years, with a higher rate of stroke in patients with diabetes than those without diabetes. The results are consistent with the results of previous studies [3,5,6]. To the best of our knowledge, this is the largest cohort study (n = 6,796) investigating the incidence rate of stroke among PD patients to the present time.…”

“…In a retrospective large cohort study from Taiwan (n = 5,974), Wang et al [6] reported the incidence of stroke was 15.9/1,000 patient-years among PD patients. In a prospective PD patient cohort study (n = 305), Fu et al [3] revealed the incidence of stroke among PD patients in southern China was 31.8/1,000 patient-years. Our study revealed the incidence of stroke among PD patients was 23.5/1,000 patient-years, with a higher rate of stroke in patients with diabetes than those without diabetes.…”

“…The impact of reduced glomerular filtration rate on the risk of stroke was higher in Asians than in non-Asians [2]. Stroke occurred much more frequently in dialysis patients than that in the general population and all stages of CKD patients not yet on dialysis [3][4][5][6]. Wang et al [6] reported that dialysis patients in Taiwan had a 2-to 6-times high- er risk of stroke as compared with age-and sex-matched general population.…”

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

“…2) to better identify those that would mostly benefit from anticoagulation: if [1] CHADS 2 score (Congestive heart failure, Hypertension, age ≥75 years, Diabetes mellitus, Stroke [double weight]) ≥2 or [2] under 2 but age ≥75 or [3] ≥1 and age between 65 and 74 years/female sex/vascular heart disease, bleeding risk should be calculated (HAS-BLED score -Hypertension, Abnormal renal and liver function, Stroke, Bleeding Labile international normalized ratio, Elderly, Drugs or alcohol – with recurrent falls, dementia and cancer as additional factors) for the opportunity of oral anticoagulation; if the bleeding risk is low-to-intermediate (HAS-BLED = 0–2), then anticoagulation with NOAC or VKA is proposed [20]. …”

“…The incidence of stroke is indeed disproportionately higher in CKD patients and especially in end-stage renal disease (ESRD): 14.9–49 per 1,000 person-years in ESRD [2, 3] compared to 0.41–2.38 per 1,000 persons/year in the general population worldwide [4]; concurrently, stroke may cause renal impairment [5] and figures describing the 2-way “cerebro-renal” relationship are similar: CKD stage 3 or higher increases the risk for stroke by 43% [6], while post- (ischaemic) stroke kidney dysfunction occurs in up to 40% stroke survivors among the general population [5]. …”