Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Sep;54(3):468-77.
doi: 10.1053/j.ajkd.2009.01.261. Epub 2009 Apr 19.

Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the choices for healthy outcomes in caring for ESRD (CHOICE) study

Stephen M Sozio  1 , Paige A Armstrong, Josef Coresh, Bernard G Jaar, Nancy E Fink, Laura C Plantinga, Neil R Powe, Rulan S Parekh
Affiliations
Comparative Study

Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the choices for healthy outcomes in caring for ESRD (CHOICE) study

Stephen M Sozio et al. Am J Kidney Dis. 2009 Sep.

Abstract

Background: Stroke is the third most common cause of cardiovascular disease death in patients on dialysis therapy; however, characteristics of cerebrovascular disease, including clinical subtypes and subsequent consequences, have not been well described.

Study design: Prospective national cohort study, the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.

Settings & participants: 1,041 incident dialysis patients treated in 81 clinics enrolled from October 1995 to July 1998, followed up until December 31, 2004.

Predictor: Time from dialysis therapy initiation.

Outcomes & measurements: Cerebrovascular disease events were defined as nonfatal (hospitalized stroke and carotid endarterectomy) and fatal (stroke death) events after dialysis therapy initiation. Stroke subtypes were classified by using standardized criteria from the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system. The incidence of cerebrovascular event subtypes was analyzed by using time-to-event analyses accounting for competing risk of death. Clinical outcomes after stroke were abstracted from medical records.

Results: 165 participants experienced a cerebrovascular event with an overall incidence of 4.9 events/100 person-years. Ischemic stroke was the most common (76% of all 200 events), with cardioembolism subtype accounting for 28% of the 95 abstracted ischemic events. Median time from onset of symptoms to first stroke evaluation was 8.5 hours (25th and 75th percentiles, 1 and 42), with only 56% of patients successfully escaping death, nursing home, or skilled nursing facility.

Limitations: Relatively small sample size limits power to determine risk factors.

Conclusions: Cerebrovascular disease is common in dialysis patients, is identified late, and carries a significant risk of morbidity and mortality. Stroke etiologic subtypes on dialysis therapy are multifactorial, suggesting risk factors may change the longer one has end-stage renal disease. Additional studies are needed to address the poor prognosis through prevention, early identification, and treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Cerebrovascular Event Classification in 1,041 Incident Dialysis Patients
The numbers of each cerebrovascular event, including recurrent events, are shown. Event types were determined from ICD-9 codes and chart abstraction. Ischemic stroke subtypes were defined using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification system by two abstractors. CEA: Carotid endarterectomy USRDS: U.S. Renal Data System *for 165 patients; 35 had repeated events †No statistically significant differences from non-abstracted patients with regard to demographics, comorbid conditions, or baseline laboratory results
Figure 2
Figure 2. Cumulative Incidence of Cerebrovascular Events in Incident Dialysis Patients
The cumulative incidence accounts for the competing risk of death from causes other than stroke. CEA: Carotid Endarterectomy
See this image and copyright information in PMC

Comment in

References

    1. U.S. Renal Data System. USRDS 2007 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD: 2007.
    1. Seliger SL, Gillen DL, Longstreth WT, Jr, et al. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int. 2003;64(2):603. - PubMed
    1. Nakatani T, Naganuma T, Uchida J, et al. Silent cerebral infarction in hemodialysis patients. Am J Nephrol. 2003;23(2):86. - PubMed
    1. Abramson JL, Jurkovitz CT, Vaccarino V, et al. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int. 2003;64(2):610. - PubMed
    1. Block GA, Klassen PS, Lazarus JM, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208. - PubMed

Publication types

MeSH terms