| Appraising stroke risk in maintenance hemodialysis patients: a large single-center cohort study. | |
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MedLine Citation:
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PMID: 21944665 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Stroke incidence in hemodialysis patients is up to 10 times greater than in the general population and is associated with a worse prognosis. Factors influencing stroke risk by subtype and subsequent prognosis are poorly described in the literature. STUDY DESIGN: Retrospective single-center cohort study. SETTING & PARTICIPANTS: 2,384 established maintenance hemodialysis patients at a single center from January 1, 2002, to June 1, 2009. PREDICTOR: Patient demographics, comorbid conditions. OUTCOMES: Incidence of acute stroke (International Classification of Diseases, 9th Revision codes 430, 431, 432.9, 433.1, and 434.1 with evidence of compatible neuroimaging), patient survival. MEASUREMENTS: Cumulative patient survival, incidence of acute fatal and nonfatal stroke. RESULTS: 127 strokes occurred during 9,541 total patient-years of follow-up. First (incident) stroke occurred at a rate of 14.9/1,000 patient years (95% CI, 12.2-17.9) with a predominance of ischemic compared with hemorrhagic subtypes (11.2 vs 3.7/1,000 patient-years). 54% of hemorrhagic strokes occurred in patients of South Asian ethnicity compared with ischemic strokes, which occurred predominantly in white patients (45% of events). Diabetes mellitus (HR, 1.92; 95% CI, 1.29-2.85; P = 0.001) and prior cerebrovascular disease (HR, 4.54; 95% CI, 3.07-6.72; P < 0.001) were independently associated with incident cerebrovascular accident on multivariate analysis. Acute stroke was associated with worse patient survival (HR, 3.26; 95% CI, 2.47-4.30; P < 0.001) and overall 1-year mortality of 24%, which was significantly worse in patients with hemorrhagic events (39% vs 19% mortality for ischemic subtypes). Serum albumin level >3.5 g/L (HR, 0.38; 95% CI, 0.19-0.76; P = 0.007) and C-reactive protein level >3.0 mg/l (HR, 1.36; 95% CI, 1.12-1.64; P = 0.002) influenced survival after stroke on multivariate analysis. LIMITATIONS: Retrospective analysis of data cannot prove causality. CONCLUSIONS: The high incidence of stroke in hemodialysis patients is associated with high mortality, especially hemorrhagic subtypes. Strict management of hypertension, better appreciation of hemodialysis anticoagulation, and large-scale interventional studies are urgently required to direct prevention and treatment of this significant disease. |
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Authors:
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Albert Power; Kakit Chan; Seema K Singh; David Taube; Neill Duncan |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2011-09-23 |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 59 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-01-16 Completed Date: 2012-03-22 Revised Date: 2012-07-09 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 249-57 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Hemodialysis Research Group, Imperial College Kidney and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom. albert.power@nhs.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult African Continental Ancestry Group Aged Asian Continental Ancestry Group Cohort Studies European Continental Ancestry Group Female Follow-Up Studies Great Britain Humans Incidence Kidney Failure, Chronic / ethnology*, mortality, therapy* Male Middle Aged Renal Dialysis* Retrospective Studies Risk Factors Stroke / epidemiology*, ethnology*, mortality Survival Rate |
| Comments/Corrections | |
Comment In:
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Am J Kidney Dis. 2012 Jun;59(6):891; author reply 891-2
[PMID:
22613396
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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