title: Risk of stroke in long-term dialysis patients compared with the general population.
abstract: BACKGROUND
  Patients undergoing maintenance dialysis are at increased risk of stroke.
  
  
  METHODS
  We performed a nationwide retrospective cohort study to determine the risks for ischemic stroke and hemorrhagic stroke among incident hemodialysis (HD) and peritoneal dialysis (PD) patients in comparison to a reference group in Taiwan.
  
  
  METHODS
  Data for 74,192 HD patients, 5,974 PD patients, and 669,773 nondialysis individuals who were older than 18 years and had no history of stroke or cancer were retrieved from the National Health Insurance Research Database for 1998-2009.
  
  
  METHODS
  Patient demographics, comorbid conditions.
  
  
  RESULTS
  First hospitalization for stroke, defined as a diagnosis at discharge (either primary or 1 of 4 secondary diagnoses) of ischemic or hemorrhagic stroke using International Classification of Diseases, Ninth Revision, Clinical Modification codes.
  
  
  RESULTS
  HD and PD patients had higher incidences of hospitalized ischemic stroke (102.6 and 100.1/10,000 person-years) and hemorrhagic stroke (74.7 and 59.4/10,000 person-years) in comparison to the age- and sex-matched reference cohort (42.4 and 13.0/10,000 person-years, respectively). In addition to HD and PD therapy, older age, male sex, diabetes, and hypertension were found to be independent risk factors for both ischemic and hemorrhagic strokes. Using the HD group as the comparison group, we found that PD patients had a lower risk of hemorrhagic stroke (HR, 0.75; 95% CI, 0.58-0.96), and there was no significant difference in risks of ischemic stroke between PD and HD patients after adjusting for all potential confounders and competing risk of death, and matched by propensity scores.
  
  
  CONCLUSIONS
  This was a retrospective study, and some important variables were not available.
  
  
  CONCLUSIONS
  Patients undergoing dialysis are at elevated risk of stroke. Patients undergoing PD appear to be less likely to develop hemorrhagic stroke than those undergoing HD. Comprehensive control of hypertension and diabetes is necessary when delivering dialysis treatment.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Hsi-Hao
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-Da Hospital/Department of Health Management, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.affiliation: Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: jdwang121@gmail.com.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D057216:Propensity Score; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
keywords: Hemodialysis; cerebrovascular disease; end-stage renal disease (ESRD); hemorrhagic stroke; ischemic stroke; peritoneal dialysis; renal replacement therapy (RRT); stroke