Ischaemic stroke in incident dialysis patients

Despite the high frequency of cardiovascular disease among the population on dialysis, there are few studies on ischaemic stroke and associated factors. The objective of the present study is to assess the prevalence of ischaemic stroke at the start of dialysis, its incidence in the course of follow-up and possible factors associated in its presentation.

All patients in our dialysis programme between 1 January 1999 and 31 December 2005 were included in the study and followed up until death, transplant, transfer out of our catchment area, or conclusion of the study on 31 December 2008. Factors analysed were age, gender, smoking habit, diabetes, hypertension, previous ischaemic stroke, ischaemic coronary disease, peripheral vascular disease and atrial fibrillation. Other factors measured in the first month of dialysis were haematocrit, urea, creatinine, lipids, calcium, phosphorus, parathyroid hormone and albumin.

Of 449 patients included in the study (age 64.4 ± 16 years), 30 commenced dialysis having had previous stroke (prevalence 6.7%). In a follow-up of 38.77 ± 29 months, 34 patients presented with one or more strokes; an incidence of 2.41/100 patient-years. Greater age [odds ratio (OR): 1.05; 95% confidence interval (CI): 1.01-1.09; P = 0.007], diabetes (OR: 2.29; 95% CI: 1.15-4.55; P = 0.018) and presence of atrial fibrillation (OR: 3.11; 95% CI: 1.53-6.32; P = 0.002) were independent predictors of stroke occurrence. Conclusions. The prevalence of ischaemic stroke is high at the commencement of dialysis, and its incidence is elevated in the course of follow-up. As with the general population, atrial fibrillation is an important factor predictive of ischaemic stroke, and as such, the clinical implication is that prophylactic anti-coagulation therapy needs to be considered for these individuals.