title: Inflammatory markers and risk of cerebrovascular events in patients initiating dialysis.
abstract: OBJECTIVE
  Stroke remains a leading cause of morbidity and mortality for patients on dialysis; however, its risk factors in this population and measures to prevent it are not well understood.
  
  
  METHODS
  We investigated whether inflammation was associated with cerebrovascular events in a national US cohort of 1041 incident dialysis patients enrolled from October 1995 to June 1998 and followed until January 31, 2004. Incident cerebrovascular events were defined as nonfatal (hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. With Cox proportional hazards regression analysis accounting for the competing risk of nonstroke death, we assessed the independent event risk associated with baseline levels of multiple inflammatory markers (high-sensitivity C-reactive protein [hsCRP], interleukin-6 (IL-6), matrix metalloproteinase-3 [MMP-3], and P-selectin) and hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) use, which may have pleiotropic inflammatory effects.
  
  
  RESULTS
  165 patients experienced a cerebrovascular event during 3548 person-years of follow-up; overall incidence rate was 4.9/100 person-years. None of the inflammatory markers were associated with cerebrovascular event risk (adjusted hazard ratios [HRs] per log unit [95% confidence interval]: hsCRP, 0.97 [0.85 to 1.11]; IL-6, 1.04 [0.85 to 1.26]; MMP-3, 1.02 [0.70 to 1.48]; P-selectin, 0.98 [0.57 to 1.68]). Statin use was also not associated with significant risk of events in unadjusted (HR 1.07 [0.69 to 1.68]) or propensity-score adjusted analyses (HR 0.98 [0.61 to 1.56]).
  
  
  CONCLUSIONS
  In conclusion, neither inflammatory markers nor statin use was associated with risk of cerebrovascular events. Further studies are needed to understand the pathophysiology and prevention of stroke in patients on dialysis.
authors.affiliation: Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. ssozio@jhmi.edu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Paige A
authors.initials: PA
authors.lastname: Armstrong
authors.forename: J Craig
authors.initials: JC
authors.lastname: Longenecker
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D007249:Inflammation / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D018836:Inflammation Mediators / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators