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
. 2015 Sep 4;10(9):1585-92.
doi: 10.2215/CJN.12001214. Epub 2015 Jul 24.

Risk of Stroke in Patients with ESRD

Philip Masson  1 , Patrick J Kelly  2 , Jonathan C Craig  3 , Richard I Lindley  4 , Angela C Webster  5
Affiliations

Risk of Stroke in Patients with ESRD

Philip Masson et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: This study aimed to determine absolute and excess stroke risks in people with ESRD compared with the general population.

Design, setting, participants, & measurements: This cohort study used data linkage between the Australia and New Zealand Dialysis and Transplant Registry and hospital and death records for 10,745 people with ESRD in New South Wales from 2000 to 2010. For the general population, Australian Institute of Health and Welfare hospital usage records and Australian Bureau of Statistics census data were used. Rates and standardized incidence rate ratios of hospitalization with a stroke were calculated.

Results: People with ESRD had 640 hospitalizations with stroke in 49,472 person-years of follow-up (1294 per 100,000 person-years), and people in the general population had 338,392 hospitalizations with stroke (212 per 100,000 person-years), an incidence rate ratio of 3.32 (95% confidence interval, 3.31 to 3.33). Excess risk was greater for women (incidence rate ratio, 5.14; 95% confidence interval, 5.11 to 5.18) than men (incidence rate ratio, 2.52; 95% confidence interval, 2.51 to 2.54; P for interaction <0.001) and decreased with age. People ages 35-39 years old with ESRD had an 11 times increased risk of stroke (incidence rate ratio, 11.08; 95% confidence interval, 9.41 to 13.05), and risk in people ages ≥85 years old increased 2-fold (incidence rate ratio, 2.04; 95% confidence interval, 1.87 to 2.23; P for interaction <0.001). Excess risk was greater for intracerebral hemorrhage (incidence rate ratio, 4.18; 95% confidence interval, 4.11 to 4.26) than ischemic stroke (incidence rate ratio, 3.43; 95% confidence interval, 3.40 to 3.45; P for interaction <0.01).

Conclusions: People with ESRD have a substantially higher risk of stroke, particularly women and young people, and hemorrhagic stroke. Future work could investigate effective and safe interventions for primary and secondary prevention of stroke in people with ESRD.

Keywords: cardiovascular disease; chronic dialysis; clinical epidemiology.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Rates of hospitalization with stroke in men and women with ESRD and the general population. General population data are from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics by age, sex, and year of diagnosis. All-cause stroke includes ischemic stroke, hemorrhagic stroke, unspecified strokes, and intracranial and subarachnoid hemorrhages.
Figure 2.
Figure 2.
Incidence rate ratio for hospitalization with stroke for men and women with ESRD compared with the general population. General population data are from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics by age, sex, and year of diagnosis. All-cause stroke includes ischemic stroke, hemorrhagic stroke, unspecified strokes, and intracranial and subarachnoid hemorrhages.
Figure 3.
Figure 3.
Cumulative risk of hospitalization with stroke in men and women with ESRD. All-cause stroke includes ischemic stroke, hemorrhagic stroke, unspecified strokes, and intracranial and subarachnoid hemorrhages. 95% CI, 95% confidence interval; HR, hazard ratio.
See this image and copyright information in PMC

References

    1. Wolfe CD: The impact of stroke. Br Med Bull 56: 275–286, 2000 - PubMed
    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O’Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, 3rd, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2095–2128, 2012 - PMC - PubMed
    1. Lee JG, Lee KB, Jang IM, Roh H, Ahn MY, Woo HY, Hwang HW: Low glomerular filtration rate increases hemorrhagic transformation in acute ischemic stroke. Cerebrovasc Dis 35: 53–59, 2013 - PubMed
    1. Onoyama K, Kumagai H, Miishima T, Tsuruda H, Tomooka S, Motomura K, Fujishima M: Incidence of strokes and its prognosis in patients on maintenance hemodialysis. Jpn Heart J 27: 685–691, 1986 - PubMed
    1. Seliger SL, Gillen DL, Longstreth WT, Jr., Kestenbaum B, Stehman-Breen CO: Elevated risk of stroke among patients with end-stage renal disease. Kidney Int 64: 603–609, 2003 - PubMed

MeSH terms