Outcomes Following Ischemic Stroke in Older Patients With CKD Stages 4 and 5: A Retrospective Cohort Study.
Am J Kidney Dis
; 76(6): 784-793, 2020 12.
Article
em En
| MEDLINE
| ID: mdl-32474166
ABSTRACT
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. STUDYDESIGN:
Retrospective cohort. SETTING &PARTICIPANTS:
Patients with CKD4-5 in Medicare 2007 to 2014. EXPOSURE OR PREDICTOR Ischemic stroke in CKD4-5.OUTCOMES:
Initiation of maintenance dialysis or death. ANALYTICALAPPROACH:
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.RESULTS:
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.LIMITATIONS:
Study design cannot determine causality; lack of data for stroke severity.CONCLUSIONS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Isquemia Encefálica
/
Medição de Risco
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Insuficiência Renal Crônica
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prevalence_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2020
Tipo de documento:
Article