Inequality in Care and Differences in Outcome Following Stroke in People With ESRD

Mark D. Findlay (Corresponding Author), Jesse Dawson, Rachael MacIsaac, Alan G. Jardine, Mary Joan MacLeod, Wendy Metcalfe, Jamie P. Traynor, Patrick B. Mark

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Abstract

Introduction: Stroke rate and mortality are greater in people with end-stage renal disease (ESRD) than those without. We examined discrepancies in stroke-care in ESRD patients and its influence on mortality.

Methods: A national record-linkage cohort study of hospitalised stroke from 2005-2013. Presentation, measures of care quality (admission to stroke unit, swallow assessment, anti-thrombotic or thrombolysis use) and outcomes were compared in those with and without ESRD after propensity score matching (PSM). We examined the effect being admitted to a stroke unit on survival using Kaplan-Meier and Cox survival analyses.

Results: 8,757 people with ESRD and 61,367 people with stroke were identified. 486 ESRD patients experienced stroke over 34,551.9 years follow-up; incidence rates 25.3 (dialysis) and 4.5 (kidney transplant)/ 1000 patient-years. Following PSM, dialysis patients were less likely to be functionally independent (61.4 vs 77.7%, p<0.0001) before stroke, less frequently admitted to stroke units (64.6 vs 79.6%, p<0.001) or receive aspirin (75.3 vs 83.2%, p=0.01) than non-ESRD stroke patients. There were no significant differences in management of kidney transplant patients. Stroke with ESRD associated with higher death rate during admission: dialysis 22.9 vs 14.4%, p=0.002; transplant: 19.6 vs 9.3%, p=0.034. Managing ESRD patients on a stroke unit associated with lower risk of death at follow-up (HR 0.68, 95% CI 0.55-0.84).

Conclusions: Stroke incidence is high in ESRD. People on dialysis are functionally more dependent before stroke and less frequently receive optimal stroke care. Following stroke, death is more likely in ESRD patients. Acute stroke unit care may associate with lower mortality.
Original languageEnglish
Pages (from-to)1064-1076
Number of pages13
JournalKidney International Reports
Volume3
Issue number5
Early online date27 Apr 2018
DOIs
Publication statusPublished - Sep 2018

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Chronic Kidney Failure
Stroke
Dialysis
Propensity Score
Mortality
Transplants
Kidney
Quality of Health Care
Incidence
Deglutition
Survival Analysis
Aspirin
Cohort Studies

Keywords

  • ESRD
  • Dialysis
  • Stroke
  • Transplant Outcomes

Cite this

Findlay, M. D., Dawson, J., MacIsaac, R., Jardine, A. G., MacLeod, M. J., Metcalfe, W., ... Mark, P. B. (2018). Inequality in Care and Differences in Outcome Following Stroke in People With ESRD. Kidney International Reports, 3(5), 1064-1076. https://doi.org/10.1016/j.ekir.2018.04.011

Inequality in Care and Differences in Outcome Following Stroke in People With ESRD. / Findlay, Mark D. (Corresponding Author); Dawson, Jesse; MacIsaac, Rachael; Jardine, Alan G.; MacLeod, Mary Joan; Metcalfe, Wendy; Traynor, Jamie P.; Mark, Patrick B.

In: Kidney International Reports, Vol. 3, No. 5, 09.2018, p. 1064-1076.

Research output: Contribution to journalArticle

Findlay, MD, Dawson, J, MacIsaac, R, Jardine, AG, MacLeod, MJ, Metcalfe, W, Traynor, JP & Mark, PB 2018, 'Inequality in Care and Differences in Outcome Following Stroke in People With ESRD', Kidney International Reports, vol. 3, no. 5, pp. 1064-1076. https://doi.org/10.1016/j.ekir.2018.04.011
Findlay, Mark D. ; Dawson, Jesse ; MacIsaac, Rachael ; Jardine, Alan G. ; MacLeod, Mary Joan ; Metcalfe, Wendy ; Traynor, Jamie P. ; Mark, Patrick B. / Inequality in Care and Differences in Outcome Following Stroke in People With ESRD. In: Kidney International Reports. 2018 ; Vol. 3, No. 5. pp. 1064-1076.
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abstract = "Introduction: Stroke rate and mortality are greater in people with end-stage renal disease (ESRD) than those without. We examined discrepancies in stroke-care in ESRD patients and its influence on mortality.Methods: A national record-linkage cohort study of hospitalised stroke from 2005-2013. Presentation, measures of care quality (admission to stroke unit, swallow assessment, anti-thrombotic or thrombolysis use) and outcomes were compared in those with and without ESRD after propensity score matching (PSM). We examined the effect being admitted to a stroke unit on survival using Kaplan-Meier and Cox survival analyses.Results: 8,757 people with ESRD and 61,367 people with stroke were identified. 486 ESRD patients experienced stroke over 34,551.9 years follow-up; incidence rates 25.3 (dialysis) and 4.5 (kidney transplant)/ 1000 patient-years. Following PSM, dialysis patients were less likely to be functionally independent (61.4 vs 77.7{\%}, p<0.0001) before stroke, less frequently admitted to stroke units (64.6 vs 79.6{\%}, p<0.001) or receive aspirin (75.3 vs 83.2{\%}, p=0.01) than non-ESRD stroke patients. There were no significant differences in management of kidney transplant patients. Stroke with ESRD associated with higher death rate during admission: dialysis 22.9 vs 14.4{\%}, p=0.002; transplant: 19.6 vs 9.3{\%}, p=0.034. Managing ESRD patients on a stroke unit associated with lower risk of death at follow-up (HR 0.68, 95{\%} CI 0.55-0.84).Conclusions: Stroke incidence is high in ESRD. People on dialysis are functionally more dependent before stroke and less frequently receive optimal stroke care. Following stroke, death is more likely in ESRD patients. Acute stroke unit care may associate with lower mortality.",
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T1 - Inequality in Care and Differences in Outcome Following Stroke in People With ESRD

AU - Findlay, Mark D.

AU - Dawson, Jesse

AU - MacIsaac, Rachael

AU - Jardine, Alan G.

AU - MacLeod, Mary Joan

AU - Metcalfe, Wendy

AU - Traynor, Jamie P.

AU - Mark, Patrick B.

N1 - Acknowledgments: MF is funded by a Kidney Research UK Training Fellowship and is supported by a grant from Darlinda’s Charity for Renal Research.

PY - 2018/9

Y1 - 2018/9

N2 - Introduction: Stroke rate and mortality are greater in people with end-stage renal disease (ESRD) than those without. We examined discrepancies in stroke-care in ESRD patients and its influence on mortality.Methods: A national record-linkage cohort study of hospitalised stroke from 2005-2013. Presentation, measures of care quality (admission to stroke unit, swallow assessment, anti-thrombotic or thrombolysis use) and outcomes were compared in those with and without ESRD after propensity score matching (PSM). We examined the effect being admitted to a stroke unit on survival using Kaplan-Meier and Cox survival analyses.Results: 8,757 people with ESRD and 61,367 people with stroke were identified. 486 ESRD patients experienced stroke over 34,551.9 years follow-up; incidence rates 25.3 (dialysis) and 4.5 (kidney transplant)/ 1000 patient-years. Following PSM, dialysis patients were less likely to be functionally independent (61.4 vs 77.7%, p<0.0001) before stroke, less frequently admitted to stroke units (64.6 vs 79.6%, p<0.001) or receive aspirin (75.3 vs 83.2%, p=0.01) than non-ESRD stroke patients. There were no significant differences in management of kidney transplant patients. Stroke with ESRD associated with higher death rate during admission: dialysis 22.9 vs 14.4%, p=0.002; transplant: 19.6 vs 9.3%, p=0.034. Managing ESRD patients on a stroke unit associated with lower risk of death at follow-up (HR 0.68, 95% CI 0.55-0.84).Conclusions: Stroke incidence is high in ESRD. People on dialysis are functionally more dependent before stroke and less frequently receive optimal stroke care. Following stroke, death is more likely in ESRD patients. Acute stroke unit care may associate with lower mortality.

AB - Introduction: Stroke rate and mortality are greater in people with end-stage renal disease (ESRD) than those without. We examined discrepancies in stroke-care in ESRD patients and its influence on mortality.Methods: A national record-linkage cohort study of hospitalised stroke from 2005-2013. Presentation, measures of care quality (admission to stroke unit, swallow assessment, anti-thrombotic or thrombolysis use) and outcomes were compared in those with and without ESRD after propensity score matching (PSM). We examined the effect being admitted to a stroke unit on survival using Kaplan-Meier and Cox survival analyses.Results: 8,757 people with ESRD and 61,367 people with stroke were identified. 486 ESRD patients experienced stroke over 34,551.9 years follow-up; incidence rates 25.3 (dialysis) and 4.5 (kidney transplant)/ 1000 patient-years. Following PSM, dialysis patients were less likely to be functionally independent (61.4 vs 77.7%, p<0.0001) before stroke, less frequently admitted to stroke units (64.6 vs 79.6%, p<0.001) or receive aspirin (75.3 vs 83.2%, p=0.01) than non-ESRD stroke patients. There were no significant differences in management of kidney transplant patients. Stroke with ESRD associated with higher death rate during admission: dialysis 22.9 vs 14.4%, p=0.002; transplant: 19.6 vs 9.3%, p=0.034. Managing ESRD patients on a stroke unit associated with lower risk of death at follow-up (HR 0.68, 95% CI 0.55-0.84).Conclusions: Stroke incidence is high in ESRD. People on dialysis are functionally more dependent before stroke and less frequently receive optimal stroke care. Following stroke, death is more likely in ESRD patients. Acute stroke unit care may associate with lower mortality.

KW - ESRD

KW - Dialysis

KW - Stroke

KW - Transplant Outcomes

U2 - 10.1016/j.ekir.2018.04.011

DO - 10.1016/j.ekir.2018.04.011

M3 - Article

C2 - 30197973

VL - 3

SP - 1064

EP - 1076

JO - Kidney International Reports

JF - Kidney International Reports

SN - 2468-0249

IS - 5

ER -