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.
Department of Research (T.-H.H.), Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan.
Stroke. 2023 Dec;54(12):3054-3063. doi: 10.1161/STROKEAHA.123.043241. Epub 2023 Oct 10.
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.
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.
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]; =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]; =0.3571) and acute coronary syndrome (subdistribution hazard ratio, 0.99 [95% CI, 0.88-1.12]; =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]; <0.0001).
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.
接受透析治疗的终末期肾病患者发生中风的风险显著增加。透析方式是否与脑血管疾病有关尚不清楚。本研究比较了腹膜透析和血液透析患者发生中风的风险。
回顾性研究了 2010 年 1 月 1 日至 2014 年 12 月 31 日期间开始透析且无中风病史的 39542 名患者，使用台湾全民健康保险研究数据库。我们按照倾向评分匹配了 3809 名腹膜透析患者（平均年龄 59±13 岁，46.5%为女性）和 11427 名血液透析患者（平均年龄 59±13 岁，47.3%为女性），比例为 1:3，并随访至 2015 年 12 月 31 日。主要结局是新发急性缺血性中风。次要结局包括出血性中风、急性冠状动脉综合征和全因死亡率。采用 Cox 比例风险模型确定根据透析方式的临床结局的风险比。
中位随访 2.59 年（四分位距 1.50-3.93 年）期间，783 名（5.1%）、376 名（2.5%）和 1350 名（8.9%）患者分别发生急性缺血性中风、出血性中风和急性冠状动脉综合征。在多变量 Cox 模型中，考虑到死亡的竞争风险，腹膜透析组发生急性缺血性中风的频率高于血液透析组（亚分布风险比，1.32[95%CI，1.13-1.54]；=0.0005）。两组出血性中风（亚分布风险比，0.89[95%CI，0.70-1.14]；=0.3571）和急性冠状动脉综合征（亚分布风险比，0.99[95%CI，0.88-1.12]；=0.9080）的风险无显著治疗相关差异。腹膜透析患者的全因死亡率高于血液透析患者（调整风险比，1.24[95%CI，1.15-1.33]；<0.0001）。
与血液透析相比，腹膜透析与急性缺血性中风的风险显著增加相关。需要进一步的研究来阐明是否更积极的脑血管预防策略可能减轻接受腹膜透析患者中风的风险。
