Original InvestigationDialysisRisk of Stroke in Long-term Dialysis Patients Compared With the General Population
Section snippets
Data Source
This nationwide cohort study was based on data obtained from the National Health Insurance Research Database (NHIRD),10 which is abstracted from the reimbursement data of the National Health Insurance in Taiwan. The National Health Insurance program is a mandatory single-payer social health insurance launched on March 1, 1995, and 99.48% of citizens (23 million) were enrolled in the program by the end of 2008. This system covers most forms of treatment and the related expenses. Most
Baseline Characteristics
For January 1, 1998, to December 31, 2009, there were 73,630 (91.8%) incident HD patients and 4,364 (5.4%) incident PD patients; another 1,610 (2.0%) switched from PD to HD, and 562 (0.7%) switched from HD to PD. Because patients were grouped according to incident modality, overall, there were 74,192 HD patients and 5,974 PD patients included in this analysis. Within the same study period, 669,773 nondialysis patients were recruited into the reference cohort.
Before matching processes, mean ages
Discussion
To our knowledge, our study is the first nationwide population-based cohort study to quantify incidence rates of ischemic and hemorrhagic strokes in patients undergoing HD and PD in comparison to a reference cohort drawn from the general population. Although we found a 3-fold increased incidence rate in patients undergoing dialysis, it does not necessarily follow that such an increased risk is causally linked. However, we provide the following evidence to argue in support of such a hypothesis.
Acknowledgements
We are grateful to Jia-Ling Wu for providing statistical consulting services from the Biostatistics Consulting Center, National Cheng Kung University Hospital.
Support: This study was funded by a grant from E-Da Hospital, Kaohsiung, Taiwan (EDAHP 101024).
Financial Disclosure: The authors declare that they have no other relevant financial interests.
References (45)
- et al.
Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease
Am J Kidney Dis
(1998) - et al.
Clinical epidemiology of cardiovascular disease in chronic renal disease
Am J Kidney Dis
(1998) - et al.
Traditional and emerging cardiovascular risk factors in end-stage renal disease
Kidney Int Suppl
(2003) - et al.
Elevated risk of stroke among patients with end-stage renal disease
Kidney Int
(2003) - et al.
Evidence for high risk of cerebral hemorrhage in chronic dialysis patients
Kidney Int
(1993) - et al.
Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)
Kidney Int
(2011) - et al.
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores
J Clin Epidemiol
(2001) - et al.
Emerging analytical techniques for comparative effectiveness research
Am J Kidney Dis
(2013) - et al.
Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis
Am J Kidney Dis
(1998) - et al.
Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE Study): a case-control study
Lancet
(2010)
Appraising stroke risk in maintenance hemodialysis patients: a large single-center cohort study
Am J Kidney Dis
Consequences of hyperphosphatemia in patients with end-stage renal disease (ESRD)
Kidney Int Suppl
Deficiencies of calcium-regulatory proteins in dialysis patients: a novel concept of cardiovascular calcification in uremia
Kidney Int Suppl
Role of calcification inhibitors in the pathogenesis of vascular calcification in chronic kidney disease (CKD)
Kidney Int
Hyperhomocysteinemia, nutritional status, and cardiovascular disease in hemodialysis patients
Kidney Int
Impaired endothelial function in isolated human uremic resistance arteries
Kidney Int
Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study
Lancet
IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia—the good, the bad, and the ugly
Kidney Int
Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD
Am J Kidney Dis
Stroke in patients on maintenance hemodialysis: a 22-year single-center study
Am J Kidney Dis
Prevalence of dyslipidemic risk factors in hemodialysis and CAPD patients
Kidney Int Suppl
Heart disease and stroke statistics—2011 update: a report from the American Heart Association
Circulation
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