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Incidence of stroke before and after dialysis initiation in older patients

Anne M Murray1, Stephen Seliger, Kamakshi Lakshminarayan

  • 1Divisions of Geriatrics, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA. amurray@usrds.org

Journal of the American Society of Nephrology : JASN
|April 27, 2013
PubMed

Insights

Initiating dialysis significantly increases stroke risk, especially within the first month post-initiation for hemodialysis patients. Stroke rates stabilize at double the baseline within a year.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Public Health

Background:

  • Patients undergoing hemodialysis have a higher incidence of stroke compared to those with earlier stages of chronic kidney disease (CKD).
  • The precise impact of initiating dialysis on accelerating stroke risk remains unclear.

Purpose of the Study:

  • To investigate the association between the initiation of dialysis and the subsequent risk of stroke.
  • To quantify the temporal relationship between dialysis initiation and stroke incidence in elderly patients.

Main Methods:

  • A cohort study analyzing data from incident hemodialysis (n=20,979) and peritoneal dialysis (n=620) patients aged 67+ in 2009 with Medicare.
  • Stroke rates were compared between outpatient and inpatient hemodialysis initiators and peritoneal dialysis patients before and after dialysis initiation.
  • Analysis included stroke rates per patient-month (ppm) and per patient-year.

Main Results:

  • Stroke rates increased significantly around the time of dialysis initiation, peaking in the 30 days post-initiation.
  • Inpatient hemodialysis initiators experienced the highest peak stroke rate (1.5% ppm or 18% per patient-year).
  • Stroke rates for hemodialysis patients stabilized at approximately twice the baseline rate within one year; peritoneal dialysis patients also showed doubled stroke rates post-initiation.

Conclusions:

  • The findings suggest that the process of initiating dialysis itself may be a causal factor for strokes.
  • A critical period of elevated stroke risk exists around dialysis initiation, necessitating further research into risk mitigation strategies.

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