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Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: Two nationwide studies.

Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: Two nationwide studies.
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Cherng YG, Lin CS, Shih CC, Hsu YH, Yeh CC, Hu CJ, Chen TL, Liao CC,


Cherng YG, Lin CS, Shih CC, Hsu YH, Yeh CC, Hu CJ, Chen TL, Liao CC, (click to view)

Cherng YG, Lin CS, Shih CC, Hsu YH, Yeh CC, Hu CJ, Chen TL, Liao CC,

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PloS one 2018 01 1213(1) e0191155 doi 10.1371/journal.pone.0191155
Abstract
BACKGROUND AND AIMS
Because the risk and outcomes of stroke in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) were unclear, we evaluated these risks using a retrospective cohort study and a nested cohort study.

METHODS
We used Taiwan’s National Health Insurance Research Database to identify 1378 patients aged ≥20 years who had ESRD in 2000-2004. An age- and sex-matched CKD cohort (n = 5512) and a control cohort (n = 11,024) were selected for comparison. Events of incident stroke were considered as outcome during the follow-up period in 2000-2013, and we calculated adjusted hazard ratios (HR) and 95% CIs of stroke associated with CKD or ESRD. We further used matching procedure with propensity score to estimate the risk of stroke for control group, CKD patients, and EDRD patients. A nested cohort study of 318,638 hospitalized stroke patients between 2000 and 2010 also was conducted to analyze the impact of CKD and ESRD on post-stroke mortality.

RESULTS
Before propensity-score matching, the incidences of stroke for controls, CKD patients and ESRD patients were 6.57, 13.3, and 21.7 per 1000 person-years, respectively. Compared with control group, the adjusted HRs of stroke were 1.49 (95% CI, 1.32-1.68) and 2.39 (95% CI, 1.39-2.87) for people with CKD or ESRD respectively, and were significantly higher in both sexes and every age group. After propensity-score matching, the HRs of stroke for patients with CKD and ESRD were 1.51 (95% CI 1.24-1.85) and 2.08 (95% CI 1.32-3.26), respectively, during the follow-up period. Among hospitalized stroke patients, adjusted rate ratio (RR) of post-stroke mortality in CKD and ESRD cohorts were 1.44 (95% CI, 1.33-1.56) and 2.62 (95% CI, 2.43-2.82) respectively compared with control.

CONCLUSIONS
CKD and ESRD patient groups thus faced significantly higher risk of stroke and post-stroke mortality. Risk factor identification and preventive strategies are needed to minimize stroke risk and post-stroke mortality in these vulnerable patient groups.

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