Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, Minneapolis, MN.
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, Minneapolis, MN.
Am J Kidney Dis. 2020 Dec;76(6):784-793. doi: 10.1053/j.ajkd.2020.03.021. Epub 2020 May 28.
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.
Retrospective cohort.
SETTING & PARTICIPANTS: Patients with CKD4-5 in Medicare 2007 to 2014.
Ischemic stroke in CKD4-5.
Initiation of maintenance dialysis or death.
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.
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.
Study design cannot determine causality; lack of data for stroke severity.
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.
在晚期慢性肾脏病（CKD）患者中，尚未探讨缺血性中风与开始透析的时间和/或死亡之间的关系。我们旨在衡量 CKD 4 期和 5 期（CKD4-5）中中风的发生率和相关因素，并评估中风与开始透析和死亡的关系。
回顾性队列研究。
2007 年至 2014 年 Medicare 中 CKD4-5 患者。
CKD4-5 中的缺血性中风。
开始维持性透析或死亡。
Cox 比例风险模型评估与缺血性中风相关的因素。通过匹配分析（中风/无中风），估计作为竞争事件的新发肾功能衰竭和死亡的累积发生率。使用状态转移模型进行模拟，确定有和无 CKD5 中风的患者预期肾功能衰竭或死亡以及单独死亡的时间差异。
共确定了 123251 例 CKD4 和 22054 例 CKD5 患者。平均年龄分别为 81.0 岁和 79.2 岁。女性（HRs 分别为 1.21[95%CI，1.12-1.31]和 1.39[95%CI，1.04-1.86]）和黑人（HRs 分别为 1.25[95%CI，1.12-1.39]和 1.12[95%CI，0.80-1.58]）是与 CKD4 和 CKD5 中风相关的因素。30 天死亡率分别为 13.3%和 18.8%，1 年死亡率分别为 40.0%和 38.2%。对于 CKD5 患者，中风患者的肾功能衰竭或死亡平均提前 3.6 个月，而死亡（无论是否发生肾功能衰竭）平均提前 24.3 个月。
研究设计不能确定因果关系；缺乏中风严重程度的数据。
女性和黑人种族与 CKD4 和 CKD5 中中风风险增加相关。在 CKD5 中，中风与近 4 个月的肾功能衰竭或死亡时间缩短，与死亡时间缩短超过 2 年有关。
