Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, E-Da Hospital/Department of Health Management, I-Shou University, Kaohsiung, Taiwan.
Am J Kidney Dis. 2014 Apr;63(4):604-11. doi: 10.1053/j.ajkd.2013.10.013. Epub 2013 Nov 26.
Patients undergoing maintenance dialysis are at increased risk of stroke.
We performed a nationwide retrospective cohort study to determine the risks for ischemic stroke and hemorrhagic stroke among incident hemodialysis (HD) and peritoneal dialysis (PD) patients in comparison to a reference group in Taiwan.
SETTING & PARTICIPANTS: Data for 74,192 HD patients, 5,974 PD patients, and 669,773 nondialysis individuals who were older than 18 years and had no history of stroke or cancer were retrieved from the National Health Insurance Research Database for 1998-2009.
Patient demographics, comorbid conditions.
First hospitalization for stroke, defined as a diagnosis at discharge (either primary or 1 of 4 secondary diagnoses) of ischemic or hemorrhagic stroke using International Classification of Diseases, Ninth Revision, Clinical Modification codes.
HD and PD patients had higher incidences of hospitalized ischemic stroke (102.6 and 100.1/10,000 person-years) and hemorrhagic stroke (74.7 and 59.4/10,000 person-years) in comparison to the age- and sex-matched reference cohort (42.4 and 13.0/10,000 person-years, respectively). In addition to HD and PD therapy, older age, male sex, diabetes, and hypertension were found to be independent risk factors for both ischemic and hemorrhagic strokes. Using the HD group as the comparison group, we found that PD patients had a lower risk of hemorrhagic stroke (HR, 0.75; 95% CI, 0.58-0.96), and there was no significant difference in risks of ischemic stroke between PD and HD patients after adjusting for all potential confounders and competing risk of death, and matched by propensity scores.
This was a retrospective study, and some important variables were not available.
Patients undergoing dialysis are at elevated risk of stroke. Patients undergoing PD appear to be less likely to develop hemorrhagic stroke than those undergoing HD. Comprehensive control of hypertension and diabetes is necessary when delivering dialysis treatment.
接受维持性透析的患者发生中风的风险增加。
我们进行了一项全国性的回顾性队列研究，以确定在台湾，与参考组相比，新接受血液透析（HD）和腹膜透析（PD）治疗的患者发生缺血性中风和出血性中风的风险。
从 1998 年至 2009 年的国家健康保险研究数据库中，检索了 74192 例 HD 患者、5974 例 PD 患者和 669773 例年龄大于 18 岁且无中风或癌症病史的非透析个体的数据。
患者的人口统计学特征、合并症情况。
HD 和 PD 患者的住院缺血性中风（102.6 和 100.1/10000 人年）和出血性中风（74.7 和 59.4/10000 人年）的发生率高于年龄和性别匹配的参考队列（42.4 和 13.0/10000 人年）。除 HD 和 PD 治疗外，年龄较大、男性、糖尿病和高血压是缺血性和出血性中风的独立危险因素。与 HD 组相比，我们发现 PD 患者出血性中风的风险较低（HR，0.75；95%CI，0.58-0.96），在调整所有潜在混杂因素和死亡竞争风险并通过倾向评分匹配后，PD 和 HD 患者的缺血性中风风险无显著差异。
这是一项回顾性研究，一些重要的变量无法获得。
接受透析的患者中风风险增加。与接受 HD 治疗的患者相比，接受 PD 治疗的患者发生出血性中风的可能性较低。在进行透析治疗时，需要综合控制高血压和糖尿病。
