title: Traditional and nontraditional risk factors as predictors of cerebrovascular events in patients with end stage renal disease.
abstract: OBJECTIVE
  End stage renal disease (ESRD) patients exhibit a higher risk of cerebrovascular events as compared with the general population. In 283 ESRD patients followed up for 10 years, we investigated the long-term predictive value for stroke and transient ischemic attacks of traditional and nontraditional risk factors. Data analysis was performed by a modified Cox regression analysis for repeated events and by a competing risks analysis.
  
  
  RESULTS
  During the follow-up, 61 cerebrovascular events occurred in 47 patients. On univariate Cox analysis, the risk of cerebrovascular outcomes was directly related to age, smoking, diabetes, BMI, systolic and pulse pressures, triglycerides, hemoglobin, history of stroke/transient ischemic attacks, arrhythmia and left ventricular mass index. Nontraditional risk factors in ESRD such as norepinephrine, homocysteine, interleukin-6 and asymmetric dimethylarginine failed to predict these events. In a multivariate Cox model for repeated events only smoking [hazard ratio: 2.45, 95% confidence interval (CI): 1.29-4.65], age (hazard ratio: 1.05, 95% CI: 1.01-1.08), hemoglobin (hazard ratio: 1.28, 95% CI 1.06-1.54), triglycerides (hazard ratio: 1.04, 95% CI 1.01-1.08), pulse pressure (hazard ratio: 1.53, 95% CI 1.01-2.23) and left ventricular mass index (hazard ratio: 1.02, 95% CI 1.01-1.04) maintained an independent relationship with cerebrovascular events. The direct link between hemoglobin and cerebrovascular events was significantly stronger (P < 0.05) than that of the same variable and death.
  
  
  CONCLUSIONS
  The risk of stroke in ESRD depends mainly on traditional risk factors, high hemoglobin and left ventricular hypertrophy. Multiple interventions aimed to reduce arterial stiffness, left ventricular mass and smoking as well as to maintain hemoglobin within the recommended therapeutic range may have beneficial effects on the risk of cerebrovascular events in ESRD patients.
authors: CNR-IBIM, Reggio Calabria, Italy.
authors: Giovanni
authors: G
authors: Tripepi
authors: Francesco
authors: F
authors: Mattace-Raso
authors: Francesco
authors: F
authors: Rapisarda
authors: Benedetta
authors: B
authors: Stancanelli
authors: Lorenzo
authors: L
authors: Malatino
authors: Jacqueline
authors: J
authors: Witteman
authors: Carmine
authors: C
authors: Zoccali
authors: Francesca
authors: F
authors: Mallamaci
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology