1
|
Ma L, Sun F, Zhu K, Han Q, Sun Q. The Predictive Value of Atherogenic Index of Plasma, Non- High Density Lipoprotein Cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and Lipoprotein Combine Index for Stroke Incidence and Prognosis in Maintenance Hemodialysis Patients. Clin Interv Aging 2024; 19:1235-1245. [PMID: 38978964 PMCID: PMC11230120 DOI: 10.2147/cia.s461150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose The serum lipid level is strongly associated with atherosclerosis. However, research on the relationship between lipid-derived indices and acute ischemic stroke (AIS) occurrence in hemodialysis populations is limited. This study aimed to explore the predictive value of lipid-derived indices, including atherogenic index of plasma (AIP), Non- high density lipoprotein cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and lipoprotein combine index (LCI) in clinical practice for the occurrence and prognosis of AIS in hemodialysis patients. Methods A total of 451 patients undergoing maintenance hemodialysis were screened and 350 were enrolled in this study. The lipid parameters exhibit a progressive increase across the tertiles, with values rising from Q1 through Q3. Enrolled patients were divided into three groups (Q1, Q2, and Q3) based on tertiles of AIP, Non-HDL-C, Non-HDL-C/HDL-C, and LCI values. Kaplan-Meier curves were performed to investigate the association between the AIP, Non-HDL-C, Non-HDL-C/HDL-C, LCI and AIS-free survival in hemodialysis patients. Chi-square analysis was used to explore the association between the AIP, Non-HDL-C, Non-HDL-C/HDL-C, LCI and AIS outcomes in hemodialysis patients. AIS outcomes were assessed using the modified Rankin Scale (mRS). Results Kaplan-Meier analysis revealed that the AIS-free survival rates were significantly higher in the Q1 group compared to Q2 and Q3 groups for AIP, Non-HDL-C, Non-HDL-C/HDL-C, and LCI. Log rank tests showed statistically significant differences between the Q1 group and the Q2 and Q3 groups (p < 0.05 for all). The proportion of patients with a good outcome mRS was higher in the Q1 group compared to the Q2-Q3 groups (AIP: 0.818 vs 0.792; Non- HDL-C: 0.866 vs 0.767; Non- HDL-C/HDL-C: 0.867 vs 0.767; LCI: 0.938 vs 0.750). Conclusion The four lipid-derived parameters are effective predictors of AIS in patients undergoing hemodialysis, and AIP has a strongest correlation with the risk of AIS. Hemodialysis patients with elevated levels of the four lipid-derived indices had a higher incidence of AIS and poorer functional outcomes compared to those with lower levels. Our conclusions may require confirmation by further research in the future.
Collapse
Affiliation(s)
- Lijie Ma
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Fang Sun
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Kaiyi Zhu
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qiuxia Han
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qianmei Sun
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| |
Collapse
|
2
|
López-Gutiérrez LV, Mora-Atehortúa MI, Peláez-García S, Jaimes-Barragán FA, Saavedra-González YA, Ossa-Estrada DA, Villegas-Molina JP, Polo-Guzmán AH, Saldarriaga-Giraldo CI. [Increased risk of bleeding in patients with atrial fibrillation and chronic kidney disease on hemodialysis treated with anticoagulants. A four center serie]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:151-160. [PMID: 38325359 PMCID: PMC11160555 DOI: 10.24875/acm.23000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/14/2023] [Indexed: 02/09/2024] Open
Abstract
Background Because the benefits and risks of anticoagulation are still unknown in patients with atrial fibrillation (AF) and with chronic kidney disease (CKD) on hemodialysis. Objective The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS-2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.
Collapse
|
3
|
Peng CH, Hsieh TH, Chu TW, Lin TY, Hung SC. Dialysis Modality and Incident Stroke Among Patients With End-Stage Kidney Disease: A Registry-Based Cohort Study. Stroke 2023; 54:3054-3063. [PMID: 37814953 DOI: 10.1161/strokeaha.123.043241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Patients with end-stage kidney disease undergoing dialysis are at significant risk of stroke. Whether dialysis modality is associated with cerebrovascular disease is unclear. This study compared the risk of incident stroke in patients undergoing peritoneal dialysis or hemodialysis. METHODS Thirty-nine thousand five hundred forty-two patients without a history of stroke who initiated dialysis between January 1, 2010, and December 31, 2014 were retrospectively studied using Taiwan's National Health Insurance Research Database. We matched 3809 patients undergoing peritoneal dialysis (mean age 59±13 years; 46.5% women) and 11 427 patients undergoing hemodialysis (mean age 59±13 years; 47.3% women) by propensity score in a 1:3 ratio with follow-up through December 31, 2015. The primary outcome was incident acute ischemic stroke. Secondary outcomes included hemorrhagic stroke, acute coronary syndrome, and all-cause mortality. Cox proportional hazard models were conducted to determine hazard ratios of clinical outcomes according to the dialysis modality. RESULTS During a median follow-up of 2.59 (interquartile range 1.50-3.93) years, acute ischemic stroke, hemorrhagic stroke, and acute coronary syndrome occurred in 783 (5.1%), 376 (2.5%), and 1350 (8.9%) patients, respectively. In a multivariable Cox model that accounted for the competing risk of death, acute ischemic stroke occurred more frequently in the peritoneal dialysis group than in the hemodialysis group (subdistribution hazard ratio, 1.32 [95% CI, 1.13-1.54]; P=0.0005). There were no significant treatment-related differences in the risk of hemorrhagic stroke (subdistribution hazard ratio, 0.89 [95% CI, 0.70-1.14]; P=0.3571) and acute coronary syndrome (subdistribution hazard ratio, 0.99 [95% CI, 0.88-1.12]; P=0.9080). Patients undergoing peritoneal dialysis were more likely to die from any cause than patients undergoing hemodialysis (adjusted hazard ratio, 1.24 [95% CI, 1.15-1.33]; P<0.0001). CONCLUSIONS Peritoneal dialysis was associated with a significantly increased risk of acute ischemic stroke compared with hemodialysis. Further studies are needed to clarify whether more aggressive cerebrovascular preventive strategies might mitigate the excess risk for ischemic stroke among patients receiving peritoneal dialysis.
Collapse
Affiliation(s)
- Ching-Hsiu Peng
- Division of Nephrology (C.-H.P., T.-Y.L., S.-C.H.), Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tsung-Han Hsieh
- Department of Research (T.-H.H.), Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ting-Wen Chu
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan (T.-W.C.)
- MacKay Medical College, New Taipei City, Taiwan (T.-W.C.)
| | - Ting-Yun Lin
- Division of Nephrology (C.-H.P., T.-Y.L., S.-C.H.), Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology (C.-H.P., T.-Y.L., S.-C.H.), Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
4
|
Ma L, Han Q, Sun F, Zhu K, Sun Q. Mean Platelet Volume/Platelet Count Ratio as a Predictor of Both Incidence and Prognosis of Acute Ischemic Stroke in Hemodialysis Patients. Int J Gen Med 2023; 16:3985-3994. [PMID: 37674583 PMCID: PMC10479580 DOI: 10.2147/ijgm.s416817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose This study aimed to explore whether the mean platelet volume/platelet count ratio (MPR) has predictive value for the occurrence and prognosis of acute ischemic stroke (AIS) in hemodialysis patients. Patients and Methods A total of 402 patients undergoing maintenance hemodialysis were screened and 259 were enrolled in this study. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive power of the models. The patients enrolled in this study were divided into three groups based on the tertiles of the MPR value (Q1, Q2, and Q3). Kaplan-Meier curves were used to investigate the association between the MPR and AIS-free survival in hemodialysis patients. Chi-square analysis was performed to explore the association between the MPR and AIS outcomes in hemodialysis patients. And the AIS outcome was assessed using the modified Rankin Scale (mRS). Results MPR had a predictive value for the occurrence of AIS (AUC=0.814) in hemodialysis patients with a high sensitivity and specificity. AIS-free survival rates in the MPR Q1, MPR Q2, and MPR Q3 groups were 0.930, 0.701, and 0.360, respectively. The proportion of patients with good outcomes (mRS 0-2) was significantly greater among patients in the MPR Q1-Q2 group than in the MPR Q3 group (0.844 vs 0.745, p <0.001). Conclusion The MPR can be used as a good predictor of AIS in patients undergoing hemodialysis. Patients on hemodialysis with increased MPR levels had a higher incidence of AIS and poorer functional outcomes than those with low MPR levels.
Collapse
Affiliation(s)
- Lijie Ma
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qiuxia Han
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Fang Sun
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Kaiyi Zhu
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qianmei Sun
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| |
Collapse
|
5
|
Bobot M, Suissa L, Hak JF, Burtey S, Guillet B, Hache G. Kidney disease and stroke: epidemiology and potential mechanisms of susceptibility. Nephrol Dial Transplant 2023; 38:1940-1951. [PMID: 36754366 DOI: 10.1093/ndt/gfad029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Indexed: 02/10/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of both ischaemic and haemorrhagic stroke compared with the general population. Both acute and chronic kidney impairment are independently associated with poor outcome after the onset of a stroke, after adjustment for confounders. End-stage kidney disease (ESKD) is associated with a 7- and 9-fold increased incidence of both ischaemic and haemorrhagic strokes, respectively, poorer neurological outcome and a 3-fold higher mortality. Acute kidney injury (AKI) occurs in 12% of patients with stroke and is associated with a 4-fold increased mortality and unfavourable functional outcome. CKD patients seem to have less access to revascularisation techniques like thrombolysis and thrombectomy despite their poorer prognosis. Even if CKD patients could benefit from these specific treatments in acute ischaemic stroke, their prognosis remains poor. After thrombolysis, CKD is associated with a 40% increased risk of intracerebral haemorrhage (ICH), a 20% increase in mortality and poorer functional neurological outcomes. After thrombectomy, CKD is not associated with ICH but is still associated with increased mortality, and AKI with unfavourable outcome and mortality. The beneficial impact of gliflozins on the prevention of stroke is still uncertain. Non-traditional risk factors of stroke, like uraemic toxins, can lead to chronic cerebrovascular disease predisposing to stroke in CKD, notably through an increase in the blood-brain barrier permeability and impaired coagulation and thrombosis mechanisms. Preclinical and clinical studies are needed to specifically assess the impact of these non-traditional risk factors on stroke incidence and outcomes, aiming to optimize and identify potential therapeutic targets.
Collapse
Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
| | - Laurent Suissa
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- Unité Neurovasculaire/Stroke Center, Hôpital de la Timone, AP-HM, Marseille, France
| | - Jean-François Hak
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiologie, Hôpital de la Timone, AP-HM, Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
| | - Benjamin Guillet
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiopharmacie, AP-HM, Marseille, France
| | - Guillaume Hache
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Pharmacie, Hôpital de la Timone, AP-HM, Marseille, France
| |
Collapse
|
6
|
Wakasugi M, Narita I. Sex Differences in Cause-specific Mortality in Japanese Dialysis Patients. Intern Med 2022; 61:2831-2839. [PMID: 35228426 PMCID: PMC9593138 DOI: 10.2169/internalmedicine.8981-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The survival advantage of females over males is lost in dialysis patients in many countries. Japanese female hemodialysis patients, however, have a survival advantage over their male counterparts. This study explored causes of death that contribute to sex differences in all-cause mortality in Japanese dialysis patients. Methods Data from the Japanese Society for Dialysis Therapy registry and National Vital Statistics from 2017 and 2018 were used. Standardized mortality ratios, male-to-female mortality rate ratios, and age-adjusted differences between sexes were calculated for all-cause, cardiovascular, and non-cardiovascular mortality, as well as cause-specific mortality, in dialysis patients and the general population. Results During the 2-year study period, 41,006 and 21,254 deaths occurred in 417,740 and 225,292 patient-years in male and female dialysis patients, respectively. The age-standardized all-cause mortality ratio was 1.21 (95% confidence interval, 1.20-1.23) for male patients compared to female patients. The male-to-female mortality rate ratio for cardiovascular disease was about 1.4 in younger age categories but closer to 1.0 in older age categories. Conversely, the ratio for non-cardiovascular disease was about 1.3 in older age categories but closer to 1.0 in younger age categories. Death from infectious disease, malignancy, and heart failure contributed to 38.4%, 22.7%, and 12.1%, respectively, of the male-to-female difference in all-cause mortality of dialysis patients. Conclusion Low cardiovascular mortality in younger age categories and low non-cardiovascular mortality in older age categories contributed to the survival advantage of female Japanese dialysis patients. Infectious disease was the greatest contributor to sex differences in all-cause mortality.
Collapse
Affiliation(s)
- Minako Wakasugi
- Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| |
Collapse
|
7
|
Zhang L, Wang Z, Lv J, Zheng M, Zhu Y. Outcomes of acute ischemic stroke in kidney transplant recipients: An analysis of US Nationwide inpatient sample. Transl Neurosci 2022; 13:327-334. [PMID: 36238191 PMCID: PMC9510820 DOI: 10.1515/tnsci-2022-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
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.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , No. 95 Yong’an Road , Beijing , 100050 , China
| | - Zhipeng Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , No. 95 Yong’an Road , Beijing , 100050 , China
| | - Jingcheng Lv
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , No. 95 Yong’an Road , Beijing , 100050 , China
| | - Mengmeng Zheng
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , No. 95 Yong’an Road , Beijing , 100050 , China
| | - Yichen Zhu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , No. 95 Yong’an Road , Beijing , 100050 , China
| |
Collapse
|
8
|
Jain N, Martin BC, Dai J, Phadnis MA, Al-Hindi L, Shireman TI, Hedayati SS, Rasu RS, Mehta JL. Age Modifies Intracranial and Gastrointestinal Bleeding Risk from P2Y 12 Inhibitors in Patients Receiving Dialysis. KIDNEY360 2022; 3:1374-1383. [PMID: 36176642 PMCID: PMC9416835 DOI: 10.34067/kid.0002442022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
Background Individuals aged ≥75 years are the fastest-growing population starting dialysis for end-stage kidney disease (ESKD) due to living longer with coronary artery disease. ESKD alone can increase bleeding risk, but P2Y12 inhibitor (P2Y12-I) antiplatelet medications prescribed for cardiovascular treatment can exacerbate this risk in patients with ESKD. The age-specific rates of bleeding complications in dialysis patients with ESKD on P2Y12-I remain unclear, as does how age modifies the bleeding risk from P2Y12-I use in these patients. Methods In a retrospective cohort study, we collected data on 40,972 patients receiving maintenance hemo- or peritoneal dialysis who were newly prescribed P2Y12-I therapy between 2011 and 2015 from the USRDS registry. We analyzed the effect of age on the time to first bleed and the interactions between age and P2Y12-I type on modifying the effects of a bleed. Results Twenty percent of the cohort were aged ≥75 years. There were 3096 (8%) gastrointestinal (GI) and 1298 (3%) intracranial (IC) bleeding events during a median follow-up of 1 year. Annual incidence rates for IC bleeds were 2% in those aged <55 years and 3% in those aged ≥75 years. Rates for GI bleeds were 4% in those aged <55 years and 9% in those aged ≥75 years. On clopidogrel, prasugrel, and ticagrelor, for every decade increase in age of the cohort members, the risk of IC bleed increased by 9%, 55%, and 59%, and the risk of GI bleed increased by 21%, 28%, and 39%, respectively. At age ≥75 years, prasugrel was associated with a greater risk of IC bleed than clopidogrel. At age ≥60 years, ticagrelor was associated with a greater risk of GI bleed than clopidogrel. Conclusions More potent P2Y12-Is (prasugrel and ticagrelor) were associated with a disproportionately higher risk of IC bleed with increasing age compared with that of clopidogrel-prasugrel was much worse than clopidogrel at age ≥75 years. All three drugs were associated with only modest increase in the risk of GI bleed with every decade increase in age-ticagrelor was much worse than clopidogrel at ≥60 years of age. These results highlight the need for head-to-head clinical trials for the use of P2Y12-Is in patients with ESKD to determine age cutoffs where the risk of bleeding outweighs the benefits of thrombosis prevention.
Collapse
Affiliation(s)
- Nishank Jain
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Junqiang Dai
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas
| | - Milind A. Phadnis
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas
| | - Layth Al-Hindi
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Theresa I. Shireman
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - S. Susan Hedayati
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rafia S. Rasu
- Department of Pharmacotherapy, University of North Texas Health Sciences, Fort Worth, Texas
| | - Jawahar L. Mehta
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas
| |
Collapse
|
9
|
p-Cresyl Sulfate Predicts Ischemic Stroke among Patients on Hemodialysis: A Prospective Cohort Study. DISEASE MARKERS 2022; 2022:1358419. [PMID: 35140818 PMCID: PMC8820900 DOI: 10.1155/2022/1358419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
Background and Purpose. Hemodialysis patients face a higher risk of ischemic stroke. p-Cresyl sulfate is a typical protein-bound uremic toxin that contributes to chronic kidney disease and cardiovascular disease progression, as well as mortality in hemodialysis patients. The present study was aimed at elucidating the association between p-cresyl sulfate and the risk of ischemic stroke in hemodialysis patients. Method. Patients on hemodialysis over 6 months were enrolled in this prospective cohort study and were divided into 2 groups based on plasma p-cresyl sulfate level. The primary end point was the first episode of ischemic stroke during follow-up. The association between p-cresyl sulfate and ischemic stroke incidence was analyzed by Kaplan-Meier method and Cox proportional hazard model. Results. 220 patients were enrolled in this study. 44 patients experienced episodes of first ischemic stroke during follow-up for 87.8 (47.6-119.5) months. Kaplan-Meier analysis demonstrated that the incidence of ischemic stroke in the high p-cresyl sulfate group was significantly higher than that in the low p-cresyl sulfate group (Log-Rank
). Cox regression analysis as well proved that p-cresyl sulfate level was significantly associated with the first incidence of ischemic stroke (HR (hazard ratio) 2.332, 95% CI (95% confidence interval) 1.236-4.399,
). After being adjusted for other confounding risk factors, the results persisted significant (model 11: HR 2.061, 95% CI 1.030-4.125,
). Conclusion. Plasma p-cresyl sulfate predicts the first incidence of ischemic stroke in hemodialysis patients.
Collapse
|
10
|
Neuropathy - Exponent of Accelerated Involution in Uremia: The Role of Carbamylation. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2021-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Premature loss of functional integrity of the nervous system in chronic renal failure (CRF) as a consequence of persistent biological activities of the general uremic milieu is almost identical to its structural and functional involution during the process of physiological ageing, but disproportionate and independent of chronological age. In the hyperuremic status of CRF (urea - carbamide), forced carbamylation, as a non-enzymatic post-translational modification (NEPTM) of proteins and amino acids, by changing their biological properties and decreasing proteolysis capacity, represents pathogenetic potential of intensified molecular ageing and accelerated, pathological involution. Physiological predisposition and the exposure of neuropathy before complications of other organs and organ systems in CRF, due to the simultaneous and mutually pathogenetically related uremic lesion and the tissue and vascular segment of the nervous system, direct interest towards proteomic analytical techniques of quantification of carbamylated products as biomarkers of uremic neurotoxicity. Hypothetically, identical to the already established applications of other NEPTM products in practice, they have the potential of clinical methodology in the evaluation of uremic neuropathy and its contribution to the general prediction, but also to the change of the conventional CRF classification. In addition, the identification and therapeutic control of the substrate of accelerated involution, responsible for the amplification of not only neurological but also general degenerative processes in CRF, is attractive in the context of the well-known attitude towards aging.
Collapse
|
11
|
Mark PB, Jhund PS, Walters MR, Petrie MC, Power A, White C, Robertson M, Connolly E, Anker SD, Bhandari S, Farrington K, Kalra PA, Tomson CR, Wheeler DC, Winearls CG, McMurray JJ, Macdougall IC, Ford I. Stroke in Hemodialysis Patients Randomized to Different Intravenous Iron Strategies: A Prespecified Analysis from the PIVOTAL Trial. KIDNEY360 2021; 2:1761-1769. [PMID: 35372992 PMCID: PMC8785850 DOI: 10.34067/kid.0004272021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
Background People with kidney failure treated with hemodialysis (HD) are at increased risk of stroke compared with similarly aged people with normal kidney function. One concern is that treatment of renal anemia might increase stroke risk. We studied risk factors for stroke in a prespecified secondary analysis of a randomized, controlled trial of intravenous iron treatment strategies in HD. Methods We analyzed data from the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial, focusing on variables associated with risk of stroke. The trial randomized 2141 adults who had started HD <12 months earlier and who were receiving an erythropoiesis-stimulating agent (ESA) to high-dose IV iron administered proactively or low-dose IV iron administered reactively in a 1:1 ratio. Possible stroke events were independently adjudicated. We performed analyses to identify variables associated with stroke during follow-up and assessed survival following stroke. Results During a median 2.1 years of follow-up, 69 (3.2%) patients experienced a first postrandomization stroke. Fifty-seven (82.6%) were ischemic strokes, and 12 (17.4%) were hemorrhagic strokes. There were 34 postrandomization strokes in the proactive arm and 35 postrandomization strokes in the reactive arm (hazard ratio, 0.90; 95% confidence interval, 0.56 to 1.44; P=0.66). In multivariable models, women, diabetes, history of prior stroke at baseline, higher baseline systolic BP, lower serum albumin, and higher C-reactive protein were independently associated with stroke events during follow-up. Hemoglobin, total iron, and ESA dose were not associated with risk of stroke. Fifty-eight percent of patients with a stroke event died during follow-up compared with 23% without a stroke. Conclusions In patients on HD, stroke risk is broadly associated with risk factors previously described to increase cardiovascular risk in this population. Proactive intravenous iron does not increase stroke risk.Clinical Trial registry name and registration number: Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL), 2013-002267-25.
Collapse
Affiliation(s)
- Patrick B. Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Pardeep S. Jhund
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Matthew R. Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Albert Power
- Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | - Claire White
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Eugene Connolly
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stefan D. Anker
- Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, Hull, United Kingdom
| | - Sunil Bhandari
- Department of Cardiology, Berlin–Brandenburg Center for Regenerative Therapies, German Center for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Philip A. Kalra
- Salford Royal Hospital and University of Manchester, Manchester, United Kingdom
| | - Charles R.V. Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David C. Wheeler
- Department of Renal Medicine, University College London, London, United Kingdom
| | - Christopher G. Winearls
- Oxford Kidney Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - John J.V. McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Iain C. Macdougall
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
12
|
Jacobs LM, Gazagnes MD, Sanoussi S, Collart F, Mesquita MDCF. Cognitive impairment in a patient with COVID-19 on hemodialysis: Too dangerous to neglect! Hemodial Int 2021; 25:E44-E47. [PMID: 34133066 PMCID: PMC8444690 DOI: 10.1111/hdi.12955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/04/2021] [Accepted: 05/23/2021] [Indexed: 01/21/2023]
Abstract
Neurological manifestations of coronavirus disease 2019 (COVID-19) often have tragic repercussions. Although many reports of neurological complications of severe acute respiratory syndrome coronavirus 2 infection exist, none of them are of patients on hemodialysis, who have a fivefold greater risk of stroke than the general population. In this report, we emphasize the importance of being vigilant for mild stroke in high risk populations-such as patients on hemodialysis-with COVID-19, since these conditions have overlapping symptoms.
Collapse
Affiliation(s)
- Lucas M Jacobs
- Clinique de Nephrology, Department of Internal Medecine, CHU Brugmann, Université Libre de Brussels, Brussels, Belgium
| | | | - Said Sanoussi
- Radiology Department, CHU Brugmann, Université Libre de Brussels, Brussels, Belgium
| | - Frederic Collart
- Clinique de Nephrology, Department of Internal Medecine, CHU Brugmann, Université Libre de Brussels, Brussels, Belgium
| | - Maria do Carmo F Mesquita
- Clinique de Nephrology, Department of Internal Medecine, CHU Brugmann, Université Libre de Brussels, Brussels, Belgium
| |
Collapse
|
13
|
Aono T, Shinya Y, Miyawaki S, Sugiyama T, Kumagai I, Takenobu A, Shin M, Saito N, Teraoka A. Changes in the Risk of Stroke in Dialysis Patients: A Retrospective Analysis over the Last 40 Years. Toxins (Basel) 2021; 13:350. [PMID: 34068165 PMCID: PMC8170903 DOI: 10.3390/toxins13050350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
The stroke incidence in hemodialysis (HD) patients is high, but the associated factors remain largely unknown. This study aimed to analyze stroke incidence in HD patients and changes in risk factors. Data of 291 patients were retrospectively analyzed. The cumulative stroke incidences were 21.6% at 10 years and 31.5% at 20. Diabetic nephropathy (DN) significantly increased overall stroke (hazard ratio (HR), 2.24; 95% confidence interval (CI), 1.21-4.12; p = 0.001) and ischemic stroke (HR, 2.16; 95% CI, 1.00-4.64; p = 0.049). Patients treated with online HDF were less likely to have overall stroke (HR, 0.13; 95% CI, 0.03-0.56; p = 0.006) and ischemic stroke (HR, 0.08; 95% CI, 0.01-0.60; p = 0.014). DN (HR, 1.56; 95% CI, 1.08-2.27; p = 0.019) and age >80 years at HD initiation (20-49 years old; HR 0.13, 95% CI, 0.05-0.35, p < 0.001 and age 50-79 years; HR 0.42, 95% CI, 0.26-0.66, p < 0.001 (reference: age >80 years)) were significantly associated with stroke and/or death events. Over time, stroke risk increased in HD patients, due to the increasing number of DN. Although dialysis technology has advanced over time, these advances could not overcome other risk factors for stroke. Further increase in stroke and mortality due to aging remains a concern.
Collapse
Affiliation(s)
- Toshiya Aono
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| | - Yuki Shinya
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Isao Kumagai
- Department of Nephrology, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan;
| | - Atsumi Takenobu
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Akira Teraoka
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| |
Collapse
|
14
|
Grissi M, Boudot C, Assem M, Candellier A, Lando M, Poirot-Leclercq S, Boullier A, Bennis Y, Lenglet G, Avondo C, Lalau JD, Choukroun G, Massy ZA, Kamel S, Chillon JM, Hénaut L. Metformin prevents stroke damage in non-diabetic female mice with chronic kidney disease. Sci Rep 2021; 11:7464. [PMID: 33811249 PMCID: PMC8018962 DOI: 10.1038/s41598-021-86905-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) worsens ischemic stroke severity in both patients and animals. In mice, these poorer functional outcomes are associated with decreased brain activity of AMP-activated protein kinase (AMPK), a molecule that recently emerged as a potential therapeutic target for ischemic stroke. The antidiabetic drug metformin, a well-known activator of AMPK, has improved stroke outcomes in diabetic patients with normal renal function. We investigated whether chronic metformin pre-conditioning can rescue AMPK activity and prevent stroke damage in non-diabetic mice with CKD. Eight-week-old female C57BL/6J mice were assigned to CKD or SHAM groups. CKD was induced through right kidney cortical electrocautery, followed by left total nephrectomy. Mice were then allocated to receive metformin (200 mg/kg/day) or vehicle for 5 weeks until stroke induction by transient middle cerebral artery occlusion (tMCAO). The infarct volumes were lower in CKD mice exposed to metformin than in vehicle-treated CKD mice 24 h after tMCAO. Metformin pre-conditioning of CKD mice improved their neurological score, grip strength, and prehensile abilities. It also enhanced AMPK activation, reduced apoptosis, increased neuron survival and decreased microglia/macrophage M1 signature gene expression as well as CKD-induced activation of the canonical NF-κB pathway in the ischemic lesions of CKD mice.
Collapse
MESH Headings
- Adenylate Kinase/metabolism
- Animals
- Apoptosis/drug effects
- Body Weight
- Brain Infarction/blood
- Brain Infarction/complications
- Brain Infarction/drug therapy
- Brain Infarction/genetics
- Enzyme Activation/drug effects
- Female
- Gene Expression Regulation
- Gliosis/blood
- Gliosis/complications
- Gliosis/drug therapy
- Infarction, Middle Cerebral Artery/blood
- Infarction, Middle Cerebral Artery/complications
- Infarction, Middle Cerebral Artery/drug therapy
- Infarction, Middle Cerebral Artery/genetics
- Ischemic Preconditioning
- Macrophages/drug effects
- Macrophages/pathology
- Metformin/blood
- Metformin/pharmacology
- Metformin/therapeutic use
- Mice, Inbred C57BL
- Microglia/drug effects
- Microglia/pathology
- Models, Biological
- NF-kappa B/metabolism
- Neurons/drug effects
- Neurons/pathology
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/genetics
- Stroke/drug therapy
- Stroke/genetics
- Stroke/prevention & control
- Mice
Collapse
Affiliation(s)
- Maria Grissi
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
| | - Cédric Boudot
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
| | - Maryam Assem
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Faculty of Medicine, University of Picardie Jules Verne, 80000, Amiens, France
- Division of Nephrology, Amiens University Hospital, 80054, Amiens, France
| | - Alexandre Candellier
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Faculty of Medicine, University of Picardie Jules Verne, 80000, Amiens, France
- Division of Nephrology, Amiens University Hospital, 80054, Amiens, France
| | - Mathilde Lando
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Faculty of Medicine, University of Picardie Jules Verne, 80000, Amiens, France
- Division of Nephrology, Amiens University Hospital, 80054, Amiens, France
| | - Sabrina Poirot-Leclercq
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
| | - Agnès Boullier
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Faculty of Medicine, University of Picardie Jules Verne, 80000, Amiens, France
- Department of Biochemistry, Amiens University Hospital, 80054, Amiens, France
| | - Youssef Bennis
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Department of Clinical Pharmacology, Amiens University Hospital, 80054, Amiens, France
| | - Gaëlle Lenglet
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
| | - Carine Avondo
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
| | - Jean-Daniel Lalau
- Faculty of Medicine, University of Picardie Jules Verne, 80000, Amiens, France
- Department of Endocrinology-Diabetology-Nutrition, Amiens University Hospital, 80054, Amiens, France
- UMR_I 01, PériTox, CURS, 80054, Amiens, France
| | - Gabriel Choukroun
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Faculty of Medicine, University of Picardie Jules Verne, 80000, Amiens, France
- Division of Nephrology, Amiens University Hospital, 80054, Amiens, France
| | - Ziad A Massy
- Department of Nephrology, Ambroise Paré University Hospital, APHP, 92104, Boulogne-Billancourt, France
- Inserm U1018-Team 5, CESP, UVSQ, University Paris Saclay, 94807, Villejuif, France
- University Versailles-Saint Quentin, University Paris-Saclay, 91190, Villejuif, France
| | - Saïd Kamel
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Department of Biochemistry, Amiens University Hospital, 80054, Amiens, France
- Faculty of Pharmacy, University of Picardie Jules Verne, 80000, Amiens, France
| | - Jean-Marc Chillon
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France
- Faculty of Pharmacy, University of Picardie Jules Verne, 80000, Amiens, France
- Direction of Clinical Research, Amiens University Hospital, 80054, Amiens, France
| | - Lucie Hénaut
- UR UPJV 7517, MP3CV, CURS, Université de Picardie Jules Verne, Avenue René Laennec, 80054, Amiens, France.
| |
Collapse
|
15
|
Are You Tired of Working amid the Pandemic? The Role of Professional Identity and Job Satisfaction against Job Burnout. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249188. [PMID: 33316964 PMCID: PMC7764790 DOI: 10.3390/ijerph17249188] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
With the outbreak of novel coronavirus in 2019, most universities changed from traditional offline teaching to online teaching, which brought about a large amount of problems, including teachers' physical and mental problems. Because of teaching on the computer screen for a long period of time, the teacher lacks communication and can act casually. With long-term accumulation, the problem of teachers' job burnout has become increasingly serious. The main purpose of this study was to examine the influence of professional identity on job burnout during the period of the novel coronavirus. At the same time, this study also discussed the moderating effect of job satisfaction on professional identity and job burnout, and its relationship between job satisfaction and job burnout. During the peak period of the COVID-19 epidemic, we conducted an online survey-483 Chinese university teachers with online teaching experience completed the Teacher Professional Identity Scale, Job Satisfaction Scale, and Job Burnout Scale. The results of this study found professional identity and job satisfaction of university teachers to be significantly negative predictors of job burnout, with job satisfaction playing a moderating role between professional identity and job burnout. This study also confirmed that professional identity and job satisfaction are important factors affecting job burnout of university teachers. Therefore, this study proposed that schools should adopt more effective strategies to improve university teachers' professional identity and job satisfaction in order to reduce the practical problems of job burnout, ensure the effectiveness of online teaching, and maintain the sustainable development during the epidemic.
Collapse
|
16
|
Wetmore JB, Herzog CA, Sexter A, Gilbertson DT, Liu J, Kasner SE. Outcomes Following Ischemic Stroke in Older Patients With CKD Stages 4 and 5: A Retrospective Cohort Study. Am J Kidney Dis 2020; 76:784-793. [PMID: 32474166 PMCID: PMC8218249 DOI: 10.1053/j.ajkd.2020.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/17/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The associations between ischemic stroke and time to dialysis initiation and/or death in adults with late-stage chronic kidney disease (CKD) have not been explored. We sought to measure the rate and factors associated with stroke in CKD stages 4 and 5 (CKD4-5) and assess the association of stroke with initiation of dialysis and death. STUDY DESIGN Retrospective cohort. SETTING & PARTICIPANTS Patients with CKD4-5 in Medicare 2007 to 2014. EXPOSURE OR PREDICTOR Ischemic stroke in CKD4-5. OUTCOMES Initiation of maintenance dialysis or death. ANALYTICAL APPROACH Cox proportional hazard modeling assessed factors associated with ischemic stroke. A matched analysis (stroke/no stroke) estimated the cumulative incidence of incident kidney failure and death, treated as competing events. Simulations using a state transition model determined differences in expected time to kidney failure or death and death alone for patients with and without stroke with CKD5. RESULTS 123,251 patients with CKD4 and 22,054 with CKD5 were identified. Mean ages were 81.0 and 79.2 years, respectively. Female sex (HRs of 1.21 [95% CI, 1.12-1.31] and 1.39 [95% CI, 1.04-1.86] for CKD4 and CKD5, respectively) and black race (HRs of 1.25 [95% CI, 1.12-1.39] and 1.12 [95% CI, 0.80-1.58] for CKD4 and CKD5, respectively) were factors associated with ischemic stroke. Rates for 30-day mortality were 13.3% and 18.8%, and for 1-year mortality, 40.0% and 38.2%. For patients with CKD5, kidney failure or death occurred an average of 3.6 months sooner for patients with an ischemic stroke, and death (irrespective of kidney failure), a mean of 24.3 months sooner. LIMITATIONS Study design cannot determine causality; lack of data for stroke severity. CONCLUSIONS Female sex and black race were associated with increased risk for stroke in CKD4 and CKD5. In CKD5, stroke was associated with a shorter time to kidney failure or death by nearly 4 months, and to death, by more than 2 years.
Collapse
Affiliation(s)
- James B Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, Minneapolis, MN.
| | - Charles A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, Minneapolis, MN
| | - Anne Sexter
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - David T Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
17
|
Mark PB, Vecchio LD, Valdivielso JM, Malyszko J. Same rhythm, different song-approaches to atrial fibrillation management by cardiologists and nephrologists. Clin Kidney J 2020; 14:9-13. [PMID: 33564401 PMCID: PMC7857826 DOI: 10.1093/ckj/sfaa146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 11/26/2022] Open
Abstract
Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD), affecting 10–25% of patients requiring dialysis. Compared with the general population, patients requiring dialysis are also at increased risk of stroke, the major thromboembolic complication of AF. The evidence base for management strategies of AF specific to patients with advanced CKD is limited and not informed by randomized controlled trials. These gaps in evidence encompass rate and rhythm control strategies as well as a paucity of data informing which patients should receive anticoagulation. The European Renal Association–European Dialysis and Transplant Association and European Heart Rhythm Association undertook a survey of nephrologists and cardiologists exploring management strategies in patients with AF and CKD. We review the results of this survey, highlighting the differences in clinical approaches from cardiologists and nephrologists to these conditions. Closer collaboration between these specialties should lead to improved outcomes for patients with advanced CKD and AF. Specific issues that will need to be addressed may include healthcare burden to patients, location of clinics compared with dialysis sites and awareness of complications of treatments specific to CKD, such as calciphylaxis associated with vitamin K antagonism.
Collapse
Affiliation(s)
- Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Jose M Valdivielso
- Vascular and Renal Translational Research Group and UDETMA, IRBLleida, Lleida, Spain
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
18
|
Goel N, Jain D, Haddad DB, Shanbhogue D. Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences. J Stroke 2020; 22:306-316. [PMID: 33053946 PMCID: PMC7568986 DOI: 10.5853/jos.2020.01886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022] Open
Abstract
End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA2DS2-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.
Collapse
Affiliation(s)
- Narender Goel
- New Jersey Kidney Care, Jersey, NJ, USA
- Division of Nephrology, CarePoint Health Hospitals, Jersey, NJ, USA
- Division of Nephrology, Jersey City Medical Center, Jersey, NJ, USA
| | - Deepika Jain
- New Jersey Kidney Care, Jersey, NJ, USA
- Division of Nephrology, CarePoint Health Hospitals, Jersey, NJ, USA
- Division of Nephrology, Jersey City Medical Center, Jersey, NJ, USA
| | - Danny B. Haddad
- New Jersey Kidney Care, Jersey, NJ, USA
- Division of Nephrology, CarePoint Health Hospitals, Jersey, NJ, USA
- Division of Nephrology, Jersey City Medical Center, Jersey, NJ, USA
| | - Divya Shanbhogue
- Department of Medicine, Jersey City Medical Center, Jersey, NJ, USA
| |
Collapse
|
19
|
Akku R, Jayaprakash TP, Ogbue OD, Malhotra P, Khan S. Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review. Cureus 2020; 12:e9484. [PMID: 32874811 PMCID: PMC7455460 DOI: 10.7759/cureus.9484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
20
|
Shinya Y, Miyawaki S, Kumagai I, Sugiyama T, Takenobu A, Saito N, Teraoka A. Risk Factors and Outcomes of Cerebral Stroke in End-Stage Renal Disease Patients Receiving Hemodialysis. J Stroke Cerebrovasc Dis 2020; 29:104657. [PMID: 32037266 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/04/2020] [Accepted: 01/10/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Dialysis patients have a higher incidence of stroke, and outcomes are often poor. Diabetic nephropathy (DN) is a stroke risk-factor, but the importance is unclear in dialysis patients. This study investigated the stroke features and risk factors in hemodialysis (HD) patients. METHODS All end-stage renal disease patients undergoing HD at Teraoka Memorial Hospital dialysis center were identified, with 195 recruited. Baseline clinical characteristics were collected, and the clinical outcomes and related factors of stroke in HD patients were retrospectively analyzed. The incidence rate of stroke and mortality were calculated using Kaplan-Meier survival analysis. Factors potentially related to stroke were analyzed by the log-rank test and Cox proportional hazards model for univariate and multivariate analysis. RESULTS In total, 21.0% (41 of 195) patients developed stroke. The incidence rates of stroke per 1000 patient-years were 53.6, 65.2, and 34.0 in all HD patients, DN patients, and non-DN patients, respectively. The cumulative incidence rates of stroke in all HD patients, DN patients, and non-DN patients per 5 years, and per 10 years were 22.6%, 43.5%; 28.8%, 59.6%; and 17.6%, 31.1%, respectively. The incidence rate of stroke in the DN patients was significantly higher than in the non-DN patients (P = .013). DN was the significant risk factor for stroke by multivariate analysis (hazard ratio 2.63, 95% confidence interval 1.08-7.85; P = .032). CONCLUSIONS This study revealed the trends of stroke in HD patients at a single institution in Japan. DN was shown to be a significant risk factor for stroke in HD patients.
Collapse
Affiliation(s)
- Yuki Shinya
- Departments of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan; Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Isao Kumagai
- Departments of Nephrology, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Atsumi Takenobu
- Departments of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Teraoka
- Departments of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
| |
Collapse
|
21
|
Findlay M, MacIsaac R, MacLeod MJ, Metcalfe W, Sood MM, Traynor JP, Dawson J, Mark PB. The Association of Atrial Fibrillation and Ischemic Stroke in Patients on Hemodialysis: A Competing Risk Analysis. Can J Kidney Health Dis 2019; 6:2054358119878719. [PMID: 31632680 PMCID: PMC6767723 DOI: 10.1177/2054358119878719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background Stroke is common in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) and associated with high mortality rate. In the general population, atrial fibrillation (AF) is a major risk factor for stroke and therapeutic anticoagulation is associated with risk reduction, whereas in ESRD the relationship is less clear. Objective The purpose of this study is to demonstrate the influence of AF on stroke rates and probability in those on HD following competing risk analyses. Design A national record linkage cohort study. Setting All renal and stroke units in Scotland, UK. Patients All patients with ESRD receiving HD within Scotland from 2005 to 2013 (follow-up to 2015). Measurements Demographic, clinical, and laboratory data were linked between the Scottish Renal Registry, Scottish Stroke Care Audit, and hospital discharge data. Stroke was defined as a fatal or nonfatal event and mortality derived from national records. Methods Associations for stroke were determined using competing risk models: the cause-specific hazards model and the Fine and Gray subdistribution hazards model accounting for the competing risk of death in models of all stroke, ischemic stroke, and first-ever stroke. Results Of 5502 patients treated with HD with 12 348.6-year follow-up, 363 (6.6%) experienced stroke. The stroke incidence rate was 26.7 per 1000 patient-years. Multivariable regression on the cause-specific hazard for stroke demonstrated age, hazard ratio (HR) (95% confidence interval [CI]) = 1.04 (1.03-1.05); AF, HR (95% CI) = 1.88 (1.25-2.83); prior stroke, HR (95% CI) = 2.29 (1.48-3.54), and diabetes, HR (95% CI) = 1.92 (1.45-2.53); serum phosphate, HR (95% CI) = 2.15 (1.56-2.99); lower body weight, HR (95% CI) = 0.99 (0.98-1.00); lower hemoglobin, HR (95% CI) = 0.88 (0.77-0.99); and systolic blood pressure (BP), HR (95% CI) = 1.01 (1.00-1.02), to be associated with an increased stroke rate. In contrast, the subdistribution HRs obtained following Fine and Gray regression demonstrated that AF, weight, and hemoglobin were not associated with stroke risk. In both models, AF was significantly associated with nonstroke death. Limitations Our analyses derive from retrospective data sets and thus can only describe association not causation. Data on anticoagulant use are not available. Conclusions The incidence of stroke in HD patients is high. The competing risk of "prestroke" mortality affects the relationship between AF and risk of future stroke. Trial designs for interventions to reduce stroke risk in HD patients, such as anticoagulation for AF, should take account of competing risks affecting associations between risk factors and outcomes.
Collapse
Affiliation(s)
- Mark Findlay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.,The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, UK
| | - Rachael MacIsaac
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Mary Joan MacLeod
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, UK.,On Behalf of the Scottish Stroke Care Audit, Information Services Division, Edinburgh, UK
| | - Wendy Metcalfe
- Department of Renal Medicine, Royal Infirmary of Edinburgh, UK.,On Behalf of the Scottish Renal Registry, Information Services Division, Glasgow, UK
| | - Manish M Sood
- Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
| | - Jamie P Traynor
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, UK.,On Behalf of the Scottish Renal Registry, Information Services Division, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.,The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.,The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, UK
| |
Collapse
|
22
|
Yotsueda R, Tanaka S, Taniguchi M, Fujisaki K, Torisu K, Masutani K, Hirakata H, Kitazono T, Tsuruya K. Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis: the Q-cohort study. Nephrol Dial Transplant 2019; 33:856-864. [PMID: 29237088 DOI: 10.1093/ndt/gfx305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/14/2017] [Indexed: 12/11/2022] Open
Abstract
Background The contribution of the hemoglobin concentration to the incidence of hemorrhagic or ischemic stroke in patients undergoing hemodialysis is unclear. Methods In total, 3436 patients undergoing prevalent hemodialysis were followed up for 4 years. The primary outcome was the first development of hemorrhagic or ischemic stroke. The baseline hemoglobin concentration was divided into quartiles [hemoglobin (g/dL): Q1, ≤9.7; Q2, 9.8-10.5; Q3, 10.6-11.1; Q4, ≥11.2]. The association between the hemoglobin concentration and each type of stroke was examined using the Kaplan-Meier method and a Cox proportional hazards model. Results During the follow-up period, 76 (2.2%) patients developed hemorrhagic stroke and 139 (4.0%) developed ischemic stroke. The 4-year incidence rate of hemorrhagic stroke was significantly higher in patients with lower hemoglobin concentrations. Compared with the quartile of patients with the highest hemoglobin concentrations (Q4), the multivariable-adjusted hazard ratios for hemorrhagic stroke were 1.18 (95% confidence interval, 0.56-2.51), 1.59 (0.82-3.21) and 2.31 (1.16-4.73) in patients in Q3, Q2 and Q1, respectively. No association was identified between the 4-year incidence rate of ischemic stroke and the hemoglobin concentration. Compared with the quartile of patients with the lowest hemoglobin concentrations (Q1), the multivariable-adjusted hazard ratios for ischemic stroke were 1.17 (95% confidence interval, 0.73-1.89), 0.88 (0.51-1.51) and 1.10 (0.66-1.83) in patients in Q2, Q3 and Q4, respectively. Conclusions Our results suggest that low hemoglobin concentrations are associated with a high risk of hemorrhagic stroke, but not of ischemic stroke, in patients undergoing hemodialysis.
Collapse
Affiliation(s)
- Ryusuke Yotsueda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | | | - Kiichiro Fujisaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kumiko Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Masutani
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
23
|
Hénaut L, Grissi M, Brazier F, Assem M, Poirot-Leclercq S, Lenglet G, Boudot C, Avondo C, Boullier A, Choukroun G, Massy ZA, Kamel S, Chillon JM. Cellular and molecular mechanisms associated with ischemic stroke severity in female mice with chronic kidney disease. Sci Rep 2019; 9:6432. [PMID: 31015533 PMCID: PMC6478694 DOI: 10.1038/s41598-019-42933-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/08/2019] [Indexed: 02/08/2023] Open
Abstract
Ischemic stroke is highly prevalent in chronic kidney disease (CKD) patients and has been associated with a higher risk of neurological deterioration and in-hospital mortality. To date, little is known about the processes by which CKD worsens ischemic stroke. This work aimed to investigate the cellular and molecular mechanism associated with ischemic stroke severity in an in vivo model of CKD. CKD was induced through right kidney cortical electrocautery in 8-week-old female C57BL/6 J mice followed by left total nephrectomy. Transient middle cerebral artery occlusion (tMCAO) was performed 6 weeks after left nephrectomy. Twenty-four hours after tMCAO, the infarct volumes were significantly wider in CKD than in SHAM mice. CKD mice displayed decreased neuroscore, impaired ability to remain on rotarod device, weaker muscular strength and decreased prehensile score. Apoptosis, neuronal loss, glial cells recruitment and microglia/macrophages M1 signature genes CD32, CD86, IL-1β, IL-6, MCP1 and iNOS were significantly increased within ischemic lesions of CKD mice. This effect was associated with decreased AMP kinase phosphorylation and increased activation of the NFΚB pathway. Pharmacological targeting of AMP kinase activity, which is known to block microglia/macrophages M1 polarization, appears promising to improve stroke recovery in CKD.
Collapse
Affiliation(s)
- Lucie Hénaut
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.
| | - Maria Grissi
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France
| | - François Brazier
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.,Division of Nephrology, Amiens University Hospital, Amiens, 80054, France
| | - Maryam Assem
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.,Division of Nephrology, Amiens University Hospital, Amiens, 80054, France
| | | | - Gaëlle Lenglet
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France
| | - Cédric Boudot
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France
| | - Carine Avondo
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France
| | - Agnès Boullier
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.,Laboratory of Biochemistry, Amiens University Hospital, Amiens, 80054, France
| | - Gabriel Choukroun
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.,Division of Nephrology, Amiens University Hospital, Amiens, 80054, France
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, 92104, France.,Inserm U1018, CESP Team 5, UVSQ, Villejuif, 94807, France
| | - Saïd Kamel
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.,Laboratory of Biochemistry, Amiens University Hospital, Amiens, 80054, France
| | - Jean-Marc Chillon
- MP3CV, EA7517, CURS, Jules Verne University of Picardie, Amiens, 80025, France.,DRCI, Amiens University Hospital, Amiens, 80054, France
| |
Collapse
|
24
|
Triebswetter S, Gutjahr-Lengsfeld LJ, Schmidt KR, Drechsler C, Wanner C, Krane V. Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes. Am J Nephrol 2018; 47:30-39. [PMID: 29320770 DOI: 10.1159/000485842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data concerning long-term mortality predictors among large, purely diabetic hemodialysis collectives are scarce. METHODS We used data from a multicenter, prospective, randomized trial among 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) and its observational follow-up study. The association of 10 baseline candidate variables with mortality was assessed by Cox proportional hazards regression. RESULTS Overall, 103 participants survived the median follow-up of 11.5 years. Significant predictors of mortality were age (hazard ratio [HR] 1.03, 95% CI 1.02-1.04), cardiovascular (HR 1.42, 95% CI 1.25-1.62) and peripheral vascular disease (HR 1.55, 95% CI 1.36-1.76), higher hemoglobin A1c (HbA1c; HR 1.08, 95% CI 1.03-1.14), and loss of self-dependency (HR 1.20, 95% CI 1.03-1.39). Higher albumin (HR 0.72, 95% CI 0.59-0.89) and body mass index (BMI; HR 0.98, 95% CI 0.96-0.99) had protective associations. There was no significant association with sex, diabetes duration, and cerebrovascular diseases. Subgroup analyses by age and diabetes duration showed stronger associations of cardiovascular disease, HbA1c, albumin, BMI, and loss of self-dependency in younger patients and/or shorter diabetes duration. Loss of self-dependency and energy resources (albumin, BMI) increased mortality more severely in women, whilst the impact of cardiovascular and peripheral vascular diseases was more pronounced in men. CONCLUSION Long-term mortality risk in patients with T2DM on hemodialysis was associated with higher age, vascular diseases, HbA1c, loss of self-dependency, and low energy resources. Interestingly, it does not vary between sexes. Further individualized prognosis estimation and therapy should strongly depend on age, diabetes duration, and gender.
Collapse
Affiliation(s)
- Susanne Triebswetter
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - Lena J Gutjahr-Lengsfeld
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| | - Kay-Renke Schmidt
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| | - Christiane Drechsler
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| | - Vera Krane
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| |
Collapse
|
25
|
Wetmore JB, Mahnken JD, Phadnis MA. Association of multiple ischemic strokes with mortality in incident hemodialysis patients: an application of multistate model to determine transition probabilities in a retrospective observational cohort. BMC Nephrol 2016; 17:134. [PMID: 27655405 PMCID: PMC5031354 DOI: 10.1186/s12882-016-0350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background Little is known about the effect of multiple, or subsequent, ischemic strokes in patients receiving hemodialysis. Methods We undertook a retrospective cohort study of incident hemodialysis patients with Medicare coverage who had experienced a first ischemic stroke. Factors associated with either a subsequent ischemic stroke or death following a first new stroke were modeled. A multistate model with Cox proportional hazards was used to predict transition probabilities from first ischemic stroke to either subsequent stroke or to death, and the demographic and clinical factors associated with the respective transition probabilities were determined. Effect of a subsequent ischemic stroke on survival was quantified. Results Overall, 12,054 individuals (mean age 69.7 years, 41.3 % male, 53.0 % Caucasian and 34.0 % African-American) experienced a first new ischemic stroke. Female sex was associated with an increased risk of having a subsequent ischemic stroke (adjusted hazard ratio 1.37, 95 % confidence intervals 1.20 – 1.56, P < 0.0001); African-Americans, as compared to Caucasians, had lower likelihood of dying after a first new ischemic stroke (0.81, 0.77 – 0.85, P < 0.0001). A subsequent stroke trended towards having a higher likelihood of transitioning to death compared to a first new ischemic stroke on dialysis (1.72, 0.96 – 3.09, P = 0.071). When a subsequent ischemic stroke occurs at 24 months, probability of survival dropped >15 %, in absolute terms, from 0.254 to 0.096, with substantial drops observed at subsequent time points such that the probability of survival was more than halved. Conclusions Likelihood of subsequent ischemic stroke and of survival in hemodialysis patients appears to vary by sex and race: females are more likely than males to experience a subsequent ischemic stroke, and Caucasians are more likely than African-Americans to die after a first new ischemic stroke. The risk of a transitioning to a subsequent stroke (after having had a first) increases until about 1 year, then decreases. Subsequent strokes are associated with decreased probability of survival, an effect which increases as time since first stroke elapses. This information may be of assistance to clinicians when counseling hemodialysis patients about the implications of recurrent ischemic stroke.
Collapse
Affiliation(s)
- James B Wetmore
- Division of Nephrology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| |
Collapse
|
26
|
Yamada S, Tsuruya K, Taniguchi M, Tokumoto M, Fujisaki K, Hirakata H, Fujimi S, Kitazono T. Association Between Serum Phosphate Levels and Stroke Risk in Patients Undergoing Hemodialysis: The Q-Cohort Study. Stroke 2016; 47:2189-96. [PMID: 27507862 DOI: 10.1161/strokeaha.116.013195] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The contribution of serum phosphate levels to stroke risk in dialysis patients remains unclear. The present study aimed to elucidate the respective association between serum phosphate levels and the risk of brain hemorrhage or infarction in patients undergoing hemodialysis. METHODS A total of 3437 patients undergoing hemodialysis were followed up for a median of 3.9 years. The primary outcome was the occurrence of brain hemorrhage or infarction. Patients were divided into 4 groups based on their baseline serum phosphate levels (Q1-Q4). Stroke risk was estimated using a Cox proportional hazards model. RESULTS During the follow-up period, 75 patients experienced brain hemorrhage and 139 experienced brain infarction. The risk of brain hemorrhage was significantly higher in the highest (Q4) compared with the lowest quartile (Q1) as the reference value (multivariate-adjusted hazard ratio [95% confidence intervals]: Q1, 1.00; Q2, 1.76 [0.79-4.18]; Q3, 1.99 [0.92-4.67]; and Q4, 2.74 [1.27-6.47]; P=0.077 for trend; hazard ratio for every 1 mmol/L increase in serum phosphate level, 2.07 [1.10-3.81]; P=0.025). In contrast, the risk of brain infarction was significantly higher in Q1 (P=0.045) compared with Q3 as the reference value (Q1, 1.65 [1.01-2.73]; Q2, 1.35 [0.82-2.25]; Q3, 1.00; and Q4, 1.30 [0.77-2.20]). CONCLUSIONS Higher serum phosphate levels were associated with an increased risk of brain hemorrhage, whereas low levels were associated with an increased risk of brain infarction in hemodialysis patients. These results suggest the importance of managing serum phosphate levels within an appropriate range in hemodialysis patients. CLINICAL TRIAL REGISTRATION URL: http://www.umin.ac.jp/. Unique identifier: UMIN000000556.
Collapse
Affiliation(s)
- Shunsuke Yamada
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| | - Kazuhiko Tsuruya
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi).
| | - Masatomo Taniguchi
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| | - Masanori Tokumoto
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| | - Kiichiro Fujisaki
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| | - Hideki Hirakata
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| | - Satoru Fujimi
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| | - Takanari Kitazono
- From the Department of Medicine and Clinical Science (S.Y., K.T., K.F., T.K.) and Department of Integrated Therapy for Chronic Kidney Disease (K.T.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan (M. Tokumoto); Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan (H.H.); and Fukuoka Renal Clinic, Fukuoka, Japan (S.F., M. Taniguchi)
| |
Collapse
|
27
|
Findlay MD, Thomson PC, MacIsaac R, Jardine AG, Patel RK, Stevens KK, Rutherford E, Clancy M, Geddes CC, Dawson J, Mark PB. Risk factors and outcome of stroke in renal transplant recipients. Clin Transplant 2016; 30:918-24. [DOI: 10.1111/ctr.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mark D. Findlay
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Peter C. Thomson
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Rachael MacIsaac
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | - Alan G. Jardine
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Rajan K. Patel
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Kathryn K. Stevens
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Marc Clancy
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Colin C. Geddes
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
- The Glasgow Renal & Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| |
Collapse
|
28
|
Dad T, Weiner DE. Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages. Semin Nephrol 2016; 35:311-22. [PMID: 26355250 DOI: 10.1016/j.semnephrol.2015.06.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cerebrovascular disease and stroke are very common at all stages of chronic kidney disease (CKD), likely representing both shared risk factors as well as synergy among risk factors. More subtle ischemic brain lesions may be particularly common in the CKD population, with subtle manifestations including cognitive impairment. For individuals with nondialysis CKD, the prevention, approach to, diagnosis, and management of stroke is similar to the general, non-CKD population. For individuals with end-stage renal disease, far less is known regarding strategies to prevent stroke. Stroke prophylaxis using warfarin in dialysis patients with atrial fibrillation in particular remains of uncertain benefit. End-stage renal disease patients can be managed aggressively in the setting of acute stroke. Outcomes after stroke at all stages of CKD are poor, and improving these outcomes should be the subject of future clinical trials.
Collapse
Affiliation(s)
- Taimur Dad
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | | |
Collapse
|
29
|
Lee M, Saver JL, Hong KS, Wu YL, Huang WH, Rao NM, Ovbiagele B. Warfarin Use and Risk of Stroke in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Meta-Analysis. Medicine (Baltimore) 2016; 95:e2741. [PMID: 26871818 PMCID: PMC4753914 DOI: 10.1097/md.0000000000002741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In spite of the substantial burden of atrial fibrillation and associated elevated ischemic stroke risk in patients undergoing hemodialysis, the role of warfarin in these high-risk patients remains uncertain. Our objective was to clarify the association between warfarin use and risk of stroke for patients with atrial fibrillation undergoing dialysis.PubMed and Embase from January 1966 to January 2015 were searched to identify relevant studies. Inclusion criteria were cohort studies, patients with atrial fibrillation undergoing hemodialysis, and reported quantitative estimates of the multivariate adjusted relative risk (RR) and 95% confidence interval (CI) for future stroke associated with warfarin use. We identified 8 studies, with a total of 9539 participants and 706 stroke events. Three studies reported total stroke as primary endpoint and other studies reported ischemic stroke as primary endpoint. Pooling the results showed that warfarin use was associated with higher risk of any stroke (RR 1.50, 95% CI: 1.13-1.99). By stroke type, warfarin was not significantly linked to risk of ischemic stroke (RR 1.01, 95% CI: 0.65-1.57, P = 0.97), but was related to greater hemorrhagic stroke risk (RR 2.30, 95% CI: 1.62-3.27). Warfarin heightened overall bleeding risk (RR 1.27, 95% CI: 1.03-1.56), but not death (RR 0.67, 95% CI: 0.37-1.21).Among patients with atrial fibrillation undergoing hemodialysis, use of warfarin is associated with a higher risk of hemorrhagic stroke, but did not increase overall mortality.
Collapse
Affiliation(s)
- Meng Lee
- From the Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan (ML and YLW); Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA (JLS, NMR); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea (KSH); Division of Nephrology, Department of Internal Medicine, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan (WHH); Department of Neurosciences, Medical University of South Carolina (BO), Charleston, SC
| | | | | | | | | | | | | |
Collapse
|
30
|
Phadnis MA, Wetmore JB, Shireman TI, Ellerbeck EF, Mahnken JD. An ensemble survival model for estimating relative residual longevity following stroke: Application to mortality data in the chronic dialysis population. Stat Methods Med Res 2015; 26:2667-2680. [PMID: 26403934 DOI: 10.1177/0962280215605107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Time-dependent covariates can be modeled within the Cox regression framework and can allow both proportional and nonproportional hazards for the risk factor of research interest. However, in many areas of health services research, interest centers on being able to estimate residual longevity after the occurrence of a particular event such as stroke. The survival trajectory of patients experiencing a stroke can be potentially influenced by stroke type (hemorrhagic or ischemic), time of the stroke (relative to time zero), time since the stroke occurred, or a combination of these factors. In such situations, researchers are more interested in estimating lifetime lost due to stroke rather than merely estimating the relative hazard due to stroke. To achieve this, we propose an ensemble approach using the generalized gamma distribution by means of a semi-Markov type model with an additive hazards extension. Our modeling framework allows stroke as a time-dependent covariate to affect all three parameters (location, scale, and shape) of the generalized gamma distribution. Using the concept of relative times, we answer the research question by estimating residual life lost due to ischemic and hemorrhagic stroke in the chronic dialysis population.
Collapse
Affiliation(s)
- Milind A Phadnis
- 1 Departments of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - James B Wetmore
- 2 Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.,3 Chronic Disease Research Group, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Theresa I Shireman
- 4 Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA.,5 The Kidney Institute, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Edward F Ellerbeck
- 4 Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jonathan D Mahnken
- 1 Departments of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| |
Collapse
|
31
|
Findlay MD, Thomson PC, Fulton RL, Solbu MD, Jardine AG, Patel RK, Stevens KK, Geddes CC, Dawson J, Mark PB. Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis. Stroke 2015; 46:2477-81. [DOI: 10.1161/strokeaha.115.009095] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/23/2015] [Indexed: 12/23/2022]
Abstract
Background and Purpose—
End-stage renal disease (ESRD) requiring hemodialysis carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge on risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke.
Methods—
All adult patients receiving hemodialysis for ESRD from January 1, 2007, to December 31, 2012, were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging, and dialysis-related variables were assessed, and case-fatality was determined. Follow-up was until December 31, 2013.
Results—
A total of 1382 patients were identified (mean age, 60.5 years; 58.5% men). The prevalence of atrial fibrillation was 21.2%, and 59.4% were incident hemodialysis patients. One hundred and sixty patients (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident hemodialysis patients. Factors associated with stroke on regression analysis were prior stroke, diabetes mellitus, and age at starting renal replacement therapy. Atrial fibrillation was not significantly associated with stroke, and warfarin did not affect stroke risk in warfarin-treated patients. Fatality was 18.8% at 7 days, 26.9% at 28 days, and 56.3% at 365 days after stroke.
Conclusions—
Incidence of stroke is high in patients with ESRD on hemodialysis with high case-fatality. Incident hemodialysis patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving hemodialysis.
Collapse
Affiliation(s)
- Mark D. Findlay
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Peter C. Thomson
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Rachael L. Fulton
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Marit D. Solbu
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Alan G. Jardine
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Rajan K. Patel
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Kathryn K. Stevens
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Colin C. Geddes
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Jesse Dawson
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| | - Patrick B. Mark
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (M.D.F., R.L.F., M.D.S., A.G.J., R.K.P., K.K.S., J.D., P.B.M.); and The Glasgow Renal & Transplant Unit, South Glasgow University Hospital, Glasgow, United Kingdom (M.D.F., P.C.T., M.D.S., A.G.J., R.K.P., K.K.S., C.C.G., P.B.M.)
| |
Collapse
|