Abstract: FR-PO839

Relationship between History of Stroke before Dialysis Initiation and All-Cause Mortality in Dialysis Patients

Session Information

Category: Dialysis

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

Authors

  • Kojima, Masayasu, Daido Hospital, Nagoya, Aichi, Japan
  • Inaguma, Daijo, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  • Shimizu, Hideaki, Daido Hospital, Nagoya, Aichi, Japan
  • Koide, Shigehisa, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  • Takahashi, Kazuo, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  • Hayashi, Hiroki, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  • Hasegawa, Midori, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  • Yuzawa, Yukio, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
Background

Some reports have shown a relationship between stroke and all-cause mortality in pre-dialysis or maintenance dialysis patients. However, there are few previous studies describing the prognosis of dialysis patients whose baseline was set at the time dialysis was initiated. Therefore, we examined whether all-cause mortality differed between dialysis patients with and without a history of stroke before dialysis initiation.

Methods

The subjects were patients in the 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from October 2011 to September 2013. We determined by a survey conducted at the end of March 2015. Thus, we enrolled 1,520 subjects into the study. We classified patients into 2 groups according to the history of stroke (i.e., a stroke group and a non-stroke group). Propensity scores (PS) represented the probability of being assigned to a group with or without a history of stroke. All-cause mortality was compared in PS-matched patients by using the log-rank test for Kaplan-Meier curves. Factors contributing to all-cause mortality were examined using stepwise multivariate Cox proportional hazards analysis.

Results

There were 236 patients in each group after PS-matching. The median of follow up period was 1,318 days (interquartile range: 1,109-1,509 days). During observation, all-cause death occurred in 84 patients (35.6%) in the stroke group and 28 (11.9%) patients in the non-stroke group. Cardiovascular related death occurred in 32 patients (13.6%) in the stroke group and 10 (4.2%) patients in the non-stroke group. The all-cause mortality was significantly higher in the stroke group compared to the non-stroke group after PS-matching (Logrank test: p < 0.001). The all-cause mortality was significantly higher in the stroke group compared to the non-stroke group (hazard ratio = 5.00, 95% confidence interval = 2.81-8.90) in multivariate analysis adjusted for age, gender, comorbidity of diabetes, history of coronary artery disease, body mass index, blood pressure, hemoglobin, eGFR, use of loop diuretics, CRP, and bicarbonate.

Conclusion

History of stroke before dialysis initiation was associated with a higher all-cause mortality.