title: The impact of comorbidity on survival after hemorrhagic stroke among dialysis patients: a nationwide population-based study.
abstract: BACKGROUND
  This study was aimed at determining the outcome and examining the association between comorbidities and mortality after intracerebral hemorrhage in chronic dialysis patients.
  
  
  METHODS
  We used the Taiwan National Health Insurance Research Database and enrolled patients who underwent maintenance dialysis between 2000 and 2007. Annual incidence of intracerebral hemorrhage in patients receiving dialysis from 2000 to 2007 was determined. To identify predictors of hemorrhagic stroke, we used logistic regression model to estimate the relative ratio of factors for intracerebral hemorrhage in the most recent cohort (2007). The cumulative survival rate and comorbid conditions associated with mortality after intracerebral hemorrhage among all dialysis patients between 2000 and 2007 was calculated using the Kaplan-Meier method and Cox regression analysis.
  
  
  RESULTS
  We identified 57,261 patients on maintenance dialysis in the cohort of 2007, and 340 patients had history of intracerebral hemorrhage among them. Hypertension was the most common comorbidity of dialysis patients. The incidence rate of intracerebral hemorrhage among dialysis patients was about 0.6%. Adjusted logistic regression model showed that male gender, middle age (45-64 years), hypertension, and previous history of stroke were the independent predictors for the occurrence of intracerebral hemorrhage among chronic dialysis patients. 1,939 dialysis patients with development of intracerebral hemorrhage in the analysis period from 2000 to 2007 were identified. In-hospital mortality was high (36.15%) following intracerebral hemorrhage. They were followed up after intracerebral hemorrhage for a mean time of 41.56 months. Adjusted Cox regression analyses demonstrated that the factors independently associated with mortality after intracerebral hemorrhage among dialysis patients included diabetes mellitus, malignancy and a history of prior stroke.
  
  
  CONCLUSIONS
  Dialysis patients who have history of prior stroke, diabetes and malignancy have worse survival than patients without these comorbidities. Attention must focus on providing optimal medical care after hemorrhagic stroke for these target groups to reduce mortality.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chien
authors.forename: Hung-An
authors.initials: HA
authors.lastname: Chen
authors.forename: Fu-Mei
authors.initials: FM
authors.lastname: Su
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Wang
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Chu
authors.affiliation: Division of Allergy-Immunology-Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan. linyeongjang@yahoo.com.tw.
authors.forename: Yeong-Jang
authors.initials: YJ
authors.lastname: Lin
mesh_terms: D002543:Cerebral Hemorrhage / Q000401:mortality*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology