title: Impact of dialysis modality on the survival of patients with end-stage renal disease and prior stroke.
abstract: OBJECTIVE
  Of patients with end-stage renal disease (ESRD), 8-16 % had a history of stroke at dialysis initiation. We used the National Health Insurance Research Database of Taiwan to evaluate whether peritoneal dialysis (PD) or hemodialysis (HD) confers a survival advantage for patients with incident ESRD and prior stroke.
  
  
  METHODS
  We identified 975 patients undergoing PD and 975 propensity score-matched patients with newly diagnosed ESRD and prior stroke undergoing HD between 2000 and 2010. Both cohorts were followed up until the end of 2011. Comparisons of the risks of mortality between PD and HD were analyzed using the Cox proportional hazards regression model.
  
  
  RESULTS
  In the propensity score-matched cohorts, there was a 2.4 per 100 person-years greater mortality in patients with PD (20.4 vs. 18.0 per 100 person-years) with an adjusted hazard ratio (HR) of 1.20 (95 % CI 1.06-1.36). For patients with diabetes, ESRD and prior stroke, patients undergoing PD had inferior survival compared with those undergoing HD (adjusted HR 1.22, 95 % CI 1.05-1.43), particularly among female patients (adjusted HR 1.55, 95 % CI 1.25-1.91). For patients with ESRD and prior stroke but without diabetes, there was no significant difference in mortality between PD and HD (adjusted HR 1.20, 95 % CI 0.96-1.50).
  
  
  CONCLUSIONS
  PD was associated with overall poorer survival among patients with diabetes, ESRD and prior stroke and with similar overall survival among patients with ESRD and prior stroke, but without diabetes, compared with HD.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.|Department of Internal Medicine, College of Medicine, China Medical University, Taichung, 404, Taiwan.|Division of Nephrology, China Medical University Hospital, Taichung, 404, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, 404, Taiwan.
authors.forename: Wen-Miin
authors.initials: WM
authors.lastname: Liang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan.|Department of Health Services Administration, China Medical University College of Public Health, 91 Hsueh Shih Road, Taichung, 404, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Nephrology, China Medical University Hospital, Taichung, 404, Taiwan.
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Liu
authors.affiliation: Division of Nephrology, China Medical University Hospital, Taichung, 404, Taiwan.
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Division of Nephrology, China Medical University Hospital, Taichung, 404, Taiwan.
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan. fcsung1008@yahoo.com.|Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan. fcsung1008@yahoo.com.|Department of Health Services Administration, China Medical University College of Public Health, 91 Hsueh Shih Road, Taichung, 404, Taiwan. fcsung1008@yahoo.com.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality; D015996:Survival Rate; D013624:Taiwan; D016896:Treatment Outcome
keywords: End-stage renal disease; Hemodialysis; Peritoneal dialysis; Stroke; Survival analysis