Increased risk of mortality among haemodialysis patients with or without prior stroke: a nationwide population-based study in Taiwan.
OBJECTIVE
Patients with prior stroke (PS) undergoing chronic dialysis are at a high risk of mortality. However, little is known about the cumulative risk and survival rate of dialysis patients with long-term follow up. The aim of this study was to assess risks for mortality between patients with and without PS undergoing chronic haemodialysis (HD).


METHODS
The Taiwan National Health Insurance Research Database (NHRI-NHIRD-99182) was used and all adult patients (≥18 yr) with end stage renal disease (ESRD) who started maintenance HD between January 1, 1999, and December 31, 1999, were selected. The patients were followed from the first reported date of HD to the date of death, end of dialysis or December 31, 2008. A Cox's proportional hazard model was applied to identify the risk factors for all-cause mortality.


RESULTS
Among 5672 HD patients, 650 patients (11.5%) had PS. A higher proportion of stroke history at baseline was found in men (52.8%) and those aged ≥ 55 yr (80.9%). After adjusting for age, sex and other covariates, the patients with PS were found to have a 36 per cent increased risk of mortality compared to those without PS (HR 1.36, 95% CI: 1.22-1.52). The cumulative survival rates among HD patients without PS were 96.0 per cent at the first year, 68.4 per cent at the fifth year, and 46.7 per cent at the ninth year, and 92.9, 47.3 and 23.6 per cent, respectively, in those with PS (log-rank: P<0.001).


CONCLUSIONS
Our findings showed that PS was an important predictor for all-cause mortality and poor outcome in patients undergoing chronic HD.
Institution of Healthcare, Chung Hwa University of Medical Technology, Tainan, Taiwan, Taiwan.
Chih-Chiang
CC
Chien
Yih-Min
YM
Sun
Jhi-Joung
JJ
Wang
Chin-Chen
CC
Chu
Chin-Li
CL
Lu
Shih-Feng
SF
Wang
Jyh-Chang
JC
Hwang
Hsien-Yi
HY
Wang
Wei-Chih
WC
Kan
Yi-Hua
YH
Lu
Hung-An
HA
Chen
Chung-Ching
CC
Chio
Kao-Chang
KC
Lin
Chiou-Chuen
CC
Wu
D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D013624:Taiwan