Abstract: FR-PO840

Hemoglobin Concentrations and the Risk of Hemorrhagic and Ischemic Stroke in Patients Undergoing Hemodialysis: The Q-Cohort Study

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Yotsueda, Ryusuke, Kyushu University, Graduate School of Medical Sciences, Fukuoka City, FUKUOKA, Japan
  • Tanaka, Shigeru, Fukuoka Dental College, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka City, Japan
  • Hirakata, Hideki N., Fukuoka Renal Clinic, Fukuoka City, Japan
  • Tsuruya, Kazuhiko, Kyushu University, Graduate School of Medical Sciences, Fukuoka City, FUKUOKA, Japan
  • Kitazono, Takanari, Kyushu University, Graduate School of Medical Sciences, Fukuoka City, FUKUOKA, Japan
Background

Several lines of evidence have suggested an association between low hemoglobin concentrations and hemorrhagic stroke, and an association between high hemoglobin concentrations and ischemic stroke. However, the contribution of hemoglobin concentrations to the separate incidence of hemorrhagic or ischemic stroke in patients undergoing hemodialysis remains unclear.

Methods

A total of 3,436 participants undergoing maintenance hemodialysis were followed up for 4 years. The primary outcome was incidence of first development of hemorrhagic or ischemic stroke. Hemoglobin concentrations were divided into quartiles based on baseline data (hemoglobin [g/dL]: Q1, ≤9.7; Q2, 9.8–10.5; Q3, 10.6–11.1; Q4, ≥11.2). The associations between hemoglobin concentrations with each types of stroke were examined using Kaplan–Meier method and Cox proportional hazards model.

Results

During the follow-up period, 77 (2.2%) patients experienced hemorrhagic stroke and 141 (4.1%) experienced ischemic stroke. The 4-year incidence rate of hemorrhagic stroke was significantly higher with lower hemoglobin concentrations. Compared with the quartile of the highest hemoglobin concentrations (Q4), the multivariable-adjusted hazard ratios for hemorrhagic stroke were 1.18 (95% confidence interval, 0.56–2.51), 1.65 (0.85–3.30), and 2.16 (1.14–4.64) in patients with Q3, Q2, and Q1, respectively. There did not appear to be an association between the 4-year incidence rate of ischemic stroke and hemoglobin concentrations. Compared with the quartile of the lowest hemoglobin concentrations (Q1), the multivariable-adjusted hazard ratios for ischemic stroke were 1.19 (95% confidence interval, 0.75–1.92), 0.87 (0.50–1.49), and 1.11 (0.68–1.85) in patients with Q2, Q3, and Q4, respectively.

Conclusion

Low hemoglobin concentrations are associated with high risk of hemorrhagic stroke in patients undergoing hemodialysis. However, hemoglobin concentrations are not associated with the risk of ischemic stroke.