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.
| Original language | English |
|---|---|
| Pages (from-to) | 1564-1571 |
| Number of pages | 8 |
| Journal | Nephrology Dialysis Transplantation |
| Volume | 33 |
| Issue number | 9 |
| Early online date | 24 Oct 2017 |
| DOIs | |
| Publication status | Published - 30 Sep 2018 |
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Keywords
- Journal Article
- cardiovascular
- dialysis
- ESRD
- kidney transplantation
- stroke
Cite this
Renal replacement modality and stroke risk in end-stage renal disease-a national registry study. / Findlay, Mark (Corresponding Author); MacIsaac, Rachael; MacLeod, Mary Joan; Metcalfe, Wendy; Traynor, Jamie P; Dawson, Jesse; Mark, Patrick B.
In: Nephrology Dialysis Transplantation, Vol. 33, No. 9, 30.09.2018, p. 1564-1571.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Renal replacement modality and stroke risk in end-stage renal disease-a national registry study
AU - Findlay, Mark
AU - MacIsaac, Rachael
AU - MacLeod, Mary Joan
AU - Metcalfe, Wendy
AU - Traynor, Jamie P
AU - Dawson, Jesse
AU - Mark, Patrick B
N1 - This work was funded and supported by the Kidney Research UK Training Fellowship and Darlinda’s Charity for Renal Research grant (to M.F.).
PY - 2018/9/30
Y1 - 2018/9/30
N2 - 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.
AB - 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.
KW - Journal Article
KW - cardiovascular
KW - dialysis
KW - ESRD
KW - kidney transplantation
KW - stroke
U2 - 10.1093/ndt/gfx291
DO - 10.1093/ndt/gfx291
M3 - Article
C2 - 29069522
VL - 33
SP - 1564
EP - 1571
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
SN - 0931-0509
IS - 9
ER -