title: Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis.
abstract: OBJECTIVE
  End-stage renal disease (ESRD) requiring hemodialysis carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge on risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke.
  
  
  METHODS
  All adult patients receiving hemodialysis for ESRD from January 1, 2007, to December 31, 2012, were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging, and dialysis-related variables were assessed, and case-fatality was determined. Follow-up was until December 31, 2013.
  
  
  RESULTS
  A total of 1382 patients were identified (mean age, 60.5 years; 58.5% men). The prevalence of atrial fibrillation was 21.2%, and 59.4% were incident hemodialysis patients. One hundred and sixty patients (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident hemodialysis patients. Factors associated with stroke on regression analysis were prior stroke, diabetes mellitus, and age at starting renal replacement therapy. Atrial fibrillation was not significantly associated with stroke, and warfarin did not affect stroke risk in warfarin-treated patients. Fatality was 18.8% at 7 days, 26.9% at 28 days, and 56.3% at 365 days after stroke.
  
  
  CONCLUSIONS
  Incidence of stroke is high in patients with ESRD on hemodialysis with high case-fatality. Incident hemodialysis patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving hemodialysis.
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.). Mark.Findlay@glasgow.ac.uk.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Findlay
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Peter C
authors.initials: PC
authors.lastname: Thomson
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Fulton
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Marit D
authors.initials: MD
authors.lastname: Solbu
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Patel
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Stevens
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Colin C
authors.initials: CC
authors.lastname: Geddes
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
authors.affiliation: From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.).
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Mark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality
keywords: atrial fibrillation; diabetes mellitus; kidney failure, chronic; renal dialysis; stroke