J Korean Med Sci.  2017 Sep;32(9):1460-1467. 10.3346/jkms.2017.32.9.1460.

Risk of Stroke in Elderly Dialysis Patients

• Han SS
• Ryu DR
• Joo KW
• Lim CS
• Kim YL
• Kang SW
• Kim YS
• Kim DK

• KMID: 2385952
• DOI: http://doi.org/10.3346/jkms.2017.32.9.1460

Abstract

Despite the current knowledge about the risk of stroke and its related factors in general population, this issue in elderly patients receiving dialysis remains unresolved. Firstly, to compare the risk of stroke between hemodialysis (HD) and peritoneal dialysis (PD), data on 13,065 incident dialysis patients (aged ≥ 65 years; 10,675 in HD and 2,390 in PD) were retrieved from the Korean Health Insurance dataset. Secondly, to identify the risk factors of stroke amongst various clinical and laboratory parameters in HD, 980 elderly patients were retrospectively analyzed using an independent prospective cohort from 31 dialysis centers. For a mean duration of 1.8 years (maximum of 5 years), the risk of all cardiovascular diseases (ischemic heart disease and stroke) did not differ between HD and PD. However, when analyses were conducted separately by subtype, the risk of stroke, not ischemic heart disease, was significantly higher in HD patients than in PD patients. When the risk factors of stroke were probed after HD for a mean duration of 2.6 years (maximum of 7 years), the absolute dependence on social support, a previous history of cardiovascular disease, high levels of low-density lipoprotein cholesterol, and the use of a high number of anti-hypertensive drugs were identified as being significant. Based on the discrepancy of stroke risk between modalities and the HD-tailored risk factors of stroke, the monitoring and management of these factors may be a key strategy to reduce the risk of stroke in elderly patients receiving dialysis.

Keyword

Cardiovascular Diseases; Aged; Kidney Failure, Chronic; Renal Dialysis; Stroke

MeSH Terms

Aged*
Antihypertensive Agents
Cardiovascular Diseases
Cholesterol
Cohort Studies
Dataset
Dialysis*
Heart Diseases
Humans
Insurance, Health
Kidney Failure, Chronic
Lipoproteins
Myocardial Ischemia
Peritoneal Dialysis
Prospective Studies
Renal Dialysis
Retrospective Studies
Risk Factors
Stroke*
Antihypertensive Agents
Cholesterol
Lipoproteins

Figure

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  Fig. 1 Cumulative risk of cardiovascular disease according to the dialysis modalities. (A) Composite cardiovascular disease; (B) ischemic heart disease; and (C) stroke. Black and gray lines represent HD and PD, respectively.HD = hemodialysis, PD = peritoneal dialysis.

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  Fig. 2 Survival curves according to the development of stroke events. Black and gray lines represent stroke and non-stroke groups, respectively.

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  Fig. 3 Risk of stroke depending on the following factors: (A) Absolute dependence on social support; (B) a history of cardiovascular disease; (C) the tertiles of LDL cholesterol levels; and (D) the number of anti-hypertensive drugs used.LDL = low-density lipoprotein.

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