Zhang Lei, Wang Zhipeng, Lv Jingcheng, Zheng Mengmeng, Zhu Yichen
Department of Urology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Beijing, 100050, China.
Transl Neurosci. 2022 Sep 24;13(1):327-334. doi: 10.1515/tnsci-2022-0247. eCollection 2022 Jan 1.
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 ( = 1,833), patients with CKD G5D ( = 26,767), and those without CKD (CKD-free, = 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.
与终身透析相比，肾移植通常是终末期肾病的首选治疗方法。与接受透析治疗的慢性肾脏病（CKD）G5期患者（CKD G5D）相比，肾移植受者（KTRs）发生新中风的风险降低。然而，肾移植对中风后住院结局的益处尚未得到充分研究。本研究旨在评估KTRs和CKD G5D患者急性缺血性中风（AIS）后的住院结局。这项回顾性研究使用了美国全国住院患者样本数据库中的患者数据。2005年至2018年期间，因AIS住院的患者被分为3组，包括KTRs（n = 1833）、CKD G5D患者（n = 26767）和无CKD患者（无CKD，n = 986945）。排除CKD G1 - G4期或未明确分期以及需要透析的移植失败患者。比较了住院死亡率、医疗并发症、转至疗养院情况和住院时间（LOS）。与无CKD组相比，KTRs在住院死亡率、转至疗养院情况和LOS方面无显著更高风险，但在调整相关因素后，发生医疗并发症的风险更高。CKD G5D组在住院死亡率（调整后的优势比（aOR）：2.04，95%置信区间（CI）：1.93 - 2.15）、医疗并发症（aOR：1.49，95%CI：1.45 - 1.54）和转至疗养院情况（aOR：1.10，95%CI：1.07 - 1.13）方面风险更高，且LOS比无CKD组长0.07天（95%CI：0.06 - 0.08）。总之，与CKD G5D相比，KTRs的AIS住院结局更有利。此外，KTRs与无CKD患者在住院死亡率、转至长期护理机构情况和LOS方面的风险无显著差异。
