Abstract
Background and aimsBecause the risk and outcomes of stroke in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) were unclear, we evaluated these risks using a retrospective cohort study and a nested cohort study.MethodsWe used Taiwan’s National Health Insurance Research Database to identify 1378 patients aged ≥20 years who had ESRD in 2000–2004. An age- and sex-matched CKD cohort (n = 5512) and a control cohort (n = 11,024) were selected for comparison. Events of incident stroke were considered as outcome during the follow-up period in 2000–2013, and we calculated adjusted hazard ratios (HR) and 95% CIs of stroke associated with CKD or ESRD. We further used matching procedure with propensity score to estimate the risk of stroke for control group, CKD patients, and EDRD patients. A nested cohort study of 318,638 hospitalized stroke patients between 2000 and 2010 also was conducted to analyze the impact of CKD and ESRD on post-stroke mortality.ResultsBefore propensity-score matching, the incidences of stroke for controls, CKD patients and ESRD patients were 6.57, 13.3, and 21.7 per 1000 person-years, respectively. Compared with control group, the adjusted HRs of stroke were 1.49 (95% CI, 1.32–1.68) and 2.39 (95% CI, 1.39–2.87) for people with CKD or ESRD respectively, and were significantly higher in both sexes and every age group. After propensity-score matching, the HRs of stroke for patients with CKD and ESRD were 1.51 (95% CI 1.24–1.85) and 2.08 (95% CI 1.32–3.26), respectively, during the follow-up period. Among hospitalized stroke patients, adjusted rate ratio (RR) of post-stroke mortality in CKD and ESRD cohorts were 1.44 (95% CI, 1.33–1.56) and 2.62 (95% CI, 2.43–2.82) respectively compared with control.ConclusionsCKD and ESRD patient groups thus faced significantly higher risk of stroke and post-stroke mortality. Risk factor identification and preventive strategies are needed to minimize stroke risk and post-stroke mortality in these vulnerable patient groups.
Highlights
Chronic kidney disease (CKD) and its associated neurological complications have been recognized as a major global health concern for decades [1]
The adjusted hazard ratios (HR) of stroke were 1.49 and 2.39
Among hospitalized stroke patients, adjusted rate ratio (RR) of post-stroke mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) cohorts were 1.44 and 2.62 respectively compared with control
Summary
Chronic kidney disease (CKD) and its associated neurological complications have been recognized as a major global health concern for decades [1]. Previous studies found increased risk of stroke when non-dialysis-dependent CKD progressed to end-stage renal disease (ESRD) [5]. Recent improvements in dialysis techniques prolong lifespans, but these uremic patients develop atherogenic changes, endothelial dysfunction, and vascular calcification [2,3,6]. Due to these changes, stroke becomes a major health issue for patients with impaired renal function [1,2,6,7]. Because the risk and outcomes of stroke in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) were unclear, we evaluated these risks using a retrospective cohort study and a nested cohort study
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