Abstract
Objective: Dialysis patients have a higher incidence of stroke, and outcomes are often poor.
Diabetic nephropathy (DN) is a stroke risk-factor, but the importance is unclear in
dialysis patients. This study investigated the stroke features and risk factors in
hemodialysis (HD) patients. Methods: All end-stage renal disease patients undergoing HD at Teraoka Memorial Hospital dialysis
center were identified, with 195 recruited. Baseline clinical characteristics were
collected, and the clinical outcomes and related factors of stroke in HD patients
were retrospectively analyzed. The incidence rate of stroke and mortality were calculated
using Kaplan-Meier survival analysis. Factors potentially related to stroke were analyzed
by the log-rank test and Cox proportional hazards model for univariate and multivariate
analysis. Results: In total, 21.0% (41 of 195) patients developed stroke. The incidence rates of stroke
per 1000 patient-years were 53.6, 65.2, and 34.0 in all HD patients, DN patients,
and non-DN patients, respectively. The cumulative incidence rates of stroke in all
HD patients, DN patients, and non-DN patients per 5 years, and per 10 years were 22.6%,
43.5%; 28.8%, 59.6%; and 17.6%, 31.1%, respectively. The incidence rate of stroke
in the DN patients was significantly higher than in the non-DN patients (P = .013). DN was the significant risk factor for stroke by multivariate analysis (hazard
ratio 2.63, 95% confidence interval 1.08-7.85; P = .032). Conclusions: This study revealed the trends of stroke in HD patients at a single institution in
Japan. DN was shown to be a significant risk factor for stroke in HD patients.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evidence for high risk of cerebral hemorrhage in chronic dialysis patients.Kidney Int. 1993; 44: 1086-1090
- Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association.Circulation. 2010; 121: 948-954
- Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients.J Thromb Haemost. 2012; 10: 2484-2493
- Appraising stroke risk in maintenance hemodialysis patients: a large single-center cohort study.Am J Kidney Dis. 2012; 59: 249-257
- Elevated risk of stroke among patients with end-stage renal disease.Kidney Int. 2003; 64: 603-609
- USRDS 2009 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States.National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2009
- Traditional and emerging cardiovascular risk factors in end-stage renal disease.Kidney Int Suppl. 2003; 63: S105-S110
- Asymmetric dimethylarginine plasma concentrations differ in patients with end-stage renal disease: relationship to treatment method and atherosclerotic disease.J Am Soc Nephrol. 1999; 10: 594-600
- Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.Lancet. 2010; 376: 112-123
- Ischaemic stroke in incident dialysis patients.Nephrol Dial Transplant. 2010; 25: 3343-3348
- Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure.Lancet. 1992; 339: 572-575
- Risk of stroke in long-term dialysis patients compared with the general population.Am J Kidney Dis. 2014; 63: 604-611
- Association between serum phosphate levels and stroke risk in patients undergoing hemodialysis: the Q-Cohort Study.Stroke. 2016; 47: 2189-21966
- Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study.Lancet. 2001; 358: 2113-2117
- Cardiovascular events and all-cause mortality in a cohort of 57,946 patients with type 2 diabetes: associations with renal function and cardiovascular risk factors.Cardiovasc Diabetol. 2015; 14: 38
- Reduced kidney function and outcome in acute ischaemic stroke: relationship to arterial hypertension and diabetes.Nephrol Dial Transplant. 2012; 27: 1054-1058
- Standards of medical care in diabetes–2013.Diabetes Care. 2013; 36: S11-S66
- Risk factors for stroke in type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS) 29.Arch Intern Med. 1999; 159: 1097-1103
- Japanese Society for Dialysis Therapy clinical guideline for “hemodialysis initiation for maintenance hemodialysis”.Ther Apher Dial. 2015; 19 (1): 93-107
- KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013; 3 (() (). [Accessed June 23, 2019]): 1-150
- Risk factors of ischemic stroke and subsequent outcome in patients receiving hemodialysis.Stroke. 2015; 46: 2477-2481
- Okinawa Dialysis Study (OKIDS) Group. Clinical demographics and long-term prognosis after stroke in patients on chronic haemodialysis. The Okinawa Dialysis Study (OKIDS) Group.Nephrol Dial Transplant. 2000; 15: 1808-1813
- Risk of stroke in patients with ESRD.Clin J Am Soc Nephrol. 2015; 10: 1585-1592
- Risk factors for incident stroke among patients with end-stage renal disease.J Am Soc Nephrol. 2003; 14: 2623-2631
- Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: The choices for healthy outcomes in caring for ESRD (CHOICE) study.Am J Kidney Dis. 2009; 54: 468-477
- Trends in the incidence of stroke and cardiovascular risk factors on the isolated island of Okinawa: the Miyakojima study.J Stroke Cerebrovasc Dis. 2013; 22: e118-e123
- Atrial fibrillation and risk of stroke in dialysis patients.Ann Epidemiol. 2013; 23: 112-118
- Relationship between stroke and mortality in dialysis patients.Clin J Am Soc Nephrol. 2018; 10: 80-89
- Kurashiki Stroke Registry investigators. Stroke incidence and usage rate of thrombolysis in a Japanese urban city: the Kurashiki Stroke Registry.J Stroke Cerebrovasc Dis. 2013; 22: 349-357
- Incidence, management and short-term outcome of stroke in a general population of 1.4 million Japanese–Shiga Stroke Registry.Circ J. 2017; 81: 1636-1646
- Japanese Society for Dialysis Therapy guidelines for management of cardiovascular diseases in patients on chronic hemodialysis.Ther Apher Dial. 2012; 16: 387-435
- Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis.Am J Kidney Dis. 1998; 31: 991-996
- Incidence of strokes and its prognosis in patients on maintenance hemodialysis.Jpn Heart J. 1986; 27: 685-691
- Acute ischemic stroke associated with nephrotic syndrome: incidence and significance–retrospective cohort study.eNeurologicalSci. 2015; 1: 47-50
- investigators of the NEFRONA study. Diabetic nephropathy is an independent factor associated to severe subclinical atheromatous disease.Atherosclerosis. 2015; 242: 37-44
- Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler sonography.J Hypertens. 2005; 23: 1905-1911
- Cause of kidney disease and cardiovascular events in a national cohort of US patients with end-stage renal disease on dialysis: a retrospective analysis.Eur Heart J. 2019; 40: 887-898
- Ischemic stroke subtype classification: an Asian viewpoint.J Stroke. 2014; 16: 8-17
- Secular trends in the incidence of and risk factors for ischemic stroke and its subtypes in Japanese population.Circulation. 2008; 118: 2672-2678
- Stroke in patients on maintenance hemodialysis: a 22-year single-center study.Am J Kidney Dis. 2005; 45: 1058-1066
- Secular trends in cardiovascular disease and its risk factors in Japanese: half-century data from the Hisayama Study (1961-2009).Circulation. 2013; 128: 1198-1205
- Prognostic factors of spontaneous intracerebral haemorrhage in haemodialysis patients and predictors of 30-day mortality.Intern Med J. 2008; 38: 568-574
- Prognosis of spontaneous intracerebral hemorrhage in hemodialysis patients.Kaohsiung J Med Sci. 1999; 15: 484-490
- Clinical features and management of intracranial hemorrhage in patients undergoing maintenance dialysis therapy.Neurol Med Chir (Tokyo). 2004; 44 (discussion 233): 225-232
- The impact of comorbidity on survival after hemorrhagic stroke among dialysis patients: a nationwide population-based study.BMC Nephrol. 2014; 15: 186
- Clinical outcomes of intracerebral hemorrhage in hemodialysis patients.World Neurosurg. 2014; 81: 538-542
Article info
Publication history
Published online: February 06, 2020
Accepted:
January 10,
2020
Received in revised form:
January 4,
2020
Received:
October 1,
2019
Footnotes
Financial Disclosure: This work was supported by a Grant-in-Aid for Scientific Research (C) (No. 19K09473) to Dr. Miyawaki from the Japan Society for the Promotion of Science, grants from Mitsui Life Social Welfare Foundation to Dr. Miyawaki, and grants from MSD Life Science Foundation (Public Interest Incorporated Foundation) to Dr. Miyawaki.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104657
Copyright
© 2020 Elsevier Inc. All rights reserved.
