Outcomes of acute ischemic stroke in kidney transplant recipients: An analysis of US Nationwide inpatient sample

Abstract

A kidney transplant is often the treatment of choice for end-stage kidney disease, compared with a lifetime on dialysis. Kidney transplant recipients (KTRs) have a reduced risk for new strokes than patients with chronic kidney disease (CKD) G5 treated by dialysis (CKD G5D). However, the benefit of Kidney transplant on post-stroke hospitalization outcomes has not been well studied. This study aimed to evaluate the outcomes of hospitalization after acute ischemic stroke (AIS) in KTRs and patients with CKD G5D. This retrospective study used patient data from the US Nationwide Inpatient Sample database. From 2005 to 2018, patients hospitalized with AIS were classified into 3 groups, including KTRs (n = 1,833), patients with CKD G5D (n = 26,767), and those without CKD (CKD-free, n = 986,945). Patients with CKD G1-G4 or unspecified stage, and graft failure requiring dialysis were excluded. In-hospital mortality, medical complications, transfer to nursing homes, and length of stay (LOS) were compared. Compared to CKD-free group, KTRs had no significant higher risks for in-hospital mortality, transfer to nursing homes, and LOS, but a greater risk for medical complications after adjusting for relevant factors. CKD G5D group had higher risks for in-hospital mortality (adjusted odds ratio (aOR): 2.04, 95% confidence interval (CI): 1.93-2.15), medical complications (aOR: 1.49, 95% CI: 1.45-1.54), and transfer to nursing homes (aOR: 1.10, 95% CI: 1.07-1.13), and a 0.07 day (95% CI: 0.06-0.08) longer LOS than CKD-free group. In conclusion, the outcomes of AIS hospitalization were more favorable in KTRs as compared with CKD G5D. Furthermore, the risks for in-hospital mortality, transfer to long-term care facilities, and LOS were not significantly different between KTRs and CKD-free patients.

Keywords: acute ischemic stroke; chronic kidney disease; dialysis; kidney transplant; nationwide inpatient sample.

Figure 1

Flow diagram of study selection.

Figure 2

Impact of KTR and CKD G5D on medical complications of stroke hospitalizations. All models are adjusted by age, gender, race, household income, primary payer, reperfusion, comorbidities, year of hospitalization, hospital bed size, location/teaching status, hospital region, and hospital annual caseload of ischemic stroke.