Elevated risk of stroke among patients with end-stage renal disease.
BACKGROUND
Although end-stage renal disease (ESRD) has been associated with accelerated vascular disease of the cerebral circulation, there are no prior studies that have estimated the risk of hemorrhagic and ischemic stroke among the United States dialysis population relative to the general population.


METHODS
We performed a population-based cohort study to compare rates of hospitalized ischemic and hemorrhagic stroke among incident dialysis patients in the United States Renal System database and non-ESRD subjects from the general population identified in the National Hospital Discharge Survey.


RESULTS
After adjustment for age, gender, and race, estimated rates of hospitalized stroke were markedly higher for dialysis patients compared to the general population. The age-adjusted relative risk (RR) of stroke among dialysis patients compared to the general population was 6.1 [95% Confidence Interval (95% CI) 5.1, 7.1] for Caucasian males, 4.4 (95% CI 3.3, 5.5) for African American males, 9.7 (95%CI 8.2, 11.2) for Caucasians females and 6.2 (95%CI 4.8, 7.6) for African American females. When considered as separate outcomes, hospitalization rates for hemorrhagic and ischemic stroke were both markedly elevated for subjects treated with dialysis (ischemic, RR = 4.3 to 10.1; hemorrhagic, RR = 4.1 to 6.7).


CONCLUSIONS
Incident dialysis patients are at markedly higher risk for hospitalized stroke when compared to the general population. Although prior public health initiatives have focused primarily on cardiac disease among patients treated with dialysis, our data suggest that new initiatives are needed to control the high risk of stroke in this population.
Seliger
Stephen L
SL
Division of Nephrology, University of Washington, Seattle, Washington, USA.
Gillen
Daniel L
DL
Longstreth
W T
WT
Kestenbaum
Bryan
B
Stehman-Breen
Catherine O
CO
D001741:Black or African American / Q000706:statistics & numerical data; D002545:Brain Ischemia / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data