Risk of Stroke in Patients with ESRD

Background and objectives This study aimed to determine absolute and excess stroke risks in people with ESRD compared with the general population. Design, setting, participants, & measurements This cohort study used data linkage between the Australia and New Zealand Dialysis and Transplant Registry and hospital and death records for 10,745 people with ESRD in New South Wales from 2000 to 2010. For the general population, Australian Institute of Health and Welfare hospital usage records and Australian Bureau of Statistics census data were used. Rates and standardized incidence rate ratios of hospitalization with a stroke were calculated. Results People with ESRD had 640 hospitalizations with stroke in 49,472 person-years of follow-up (1294 per 100,000 person-years), and people in the general population had 338,392 hospitalizations with stroke (212 per 100,000 person-years), an incidence rate ratio of 3.32 (95% confidence interval, 3.31 to 3.33). Excess risk was greater forwomen (incidence rate ratio, 5.14; 95%confidence interval, 5.11 to 5.18) thanmen (incidence rate ratio, 2.52; 95% confidence interval, 2.51 to 2.54; P for interaction,0.001) and decreased with age. People ages 35–39 years oldwith ESRD had an 11 times increased risk of stroke (incidence rate ratio, 11.08; 95%confidence interval, 9.41 to 13.05), and risk in people ages $85 years old increased 2-fold (incidence rate ratio, 2.04; 95% confidence interval, 1.87 to 2.23; P for interaction,0.001). Excess risk was greater for intracerebral hemorrhage (incidence rate ratio, 4.18; 95% confidence interval, 4.11 to 4.26) than ischemic stroke (incidence rate ratio, 3.43; 95% confidence interval, 3.40 to 3.45; P for interaction,0.01). Conclusions People with ESRD have a substantially higher risk of stroke, particularlywomen and young people, and hemorrhagic stroke. Future work could investigate effective and safe interventions for primary and secondary prevention of stroke in people with ESRD.