Findlay M, et al. - The risk of stroke in end-stage renal disease (ESRD) on renal replacement therapy (RRT) is up to 10-fold greater than the general population. However, whether this increased risk differs by RRT modality remains unclear. In this study, it was demonstrated that haemodialysis (HD) use versus transplantation increased the risk of stroke in an independent manner among ESRD patients who initiated RRT, although no increase in risk was reported with the use of peritoneal dialysis, on adjusted analysis.

Methods

• Using data contained in the Scottish Renal Registry and the Scottish Stroke Care Audit, researchers identified stroke in all adult patients who commenced RRT for ESRD from 2005 to 2013.
• They calculated incidence rate and identified variables associated with stroke by performing regression analyses.
• Furthermore, they investigated the impact of RRT modality at initiation and cumulative dialysis exposure by time-dependent regression analysis, using transplant recipients as the reference group.

Results

• Data reported that overall 4957 patients commenced RRT for ESRD.
• The reported median age was 64.5 years, female constituted 41.5% and 277 patients suffered a stroke (incidence rate was 18.6/1000 patient-years).
• Researchers noted that patients who had stroke were older, had higher blood pressure and were more likely to be female and have diabetes.
• An association of older age, female sex, diabetes and higher serum phosphate with risk of stroke was evident on multivariable regression.
• RRT modality at initiation was not.
• On time-dependent analysis, an independent association of haemodialysis (HD) exposure with increased risk of stroke was obvious.