Prevalence and Impact on Stroke in Patients Receiving Maintenance Hemodialysis versus Peritoneal Dialysis: A Prospective Observational Study.
BACKGROUND
Patients undergoing maintenance dialysis are at increased risk of stroke, however, less is known about the prevalence and impact on stroke in the patients.


METHODS
In this prospective cohort study, 590 patients undergoing hemodialysis (HD; n = 285) or peritoneal dialysis (PD; n = 305) from January 1, 2008 to December 31, 2012 were recruited. Baseline demographic, clinical, and laboratory data were collected. Timeline incidence data were analyzed using a Poisson model. The Cox proportional hazards regression assessed adjusted differences in stroke risk, a multivariate analysis was also performed.


RESULTS
62 strokes occurred during 1258 total patient-years of follow-up. Stroke occurred at a rate of 49.2/1,000 patient-years with a predominance in HD patients compared with PD patients (74.0 vs. 31.8/1,000 patient-years). The cumulative hazard of developing stroke was significantly higher in HD patients (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.15-3.62; p = 0.046) after adjusting for potential confounders. HD patients had an increased risk of ischemic stroke (HR, 2.62; 95% CI, 1.56-4.58; p = 0.002). The risk of hemorrhagic stroke was not significantly different between PD and HD patients. On multivariate Cox analysis, risk factors of stroke in both HD and PD patients were older age, diabetes, and cardiovascular disease. Other independent risk factors of stroke were lower albumin-corrected calcium in HD patients and higher triglycerides in PD patients.


CONCLUSIONS
Patients undergoing PD were less likely to develop ischemic stroke than those undergoing HD. Comprehensive control of diabetes, cardiovascular disease, calcium-phosphorus metabolism, and triglyceride levels may be useful preventive strategies for stroke in dialysis patients.
Department of Nephrology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China.
Junzhou
J
Fu
Graduate School of Southern Medical University, Guangzhou 510515, China.
Jun
J
Huang
Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Ming
M
Lei
Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Zhengmao
Z
Luo
Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Xianyang
X
Zhong
Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Yuanhang
Y
Huang
Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Hong
H
Zhang
Department of Nephrology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China.
Riguang
R
Liu
Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Junrong
J
Tong
Department of Nephrology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China.
Feng
F
He
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology