Increased risk of mortality among haemodialysis patients with or without prior stroke: A nationwide population-based study in Taiwan
Chih-Chiang Chien1, Yih-Min Sun2, Jhi-Joung Wang3, Chin-Chen Chu3, Chin-Li Lu3, Shih-Feng Wang3, Jyh-Chang Hwang4, Hsien-Yi Wang4, Wei-Chih Kan5, Yi-Hua Lu4, Hung-An Chen6, Chung-Ching Chio7, Kao-Chang Lin8, Chiou-Chuen Wu9
1 Department of Nephrology, Chi-Mei Medical Center; Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
2 Department of Occupational Safety & Health, Chung Hwa University of Medical Technology, Tainan, Taiwan
3 Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
4 Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
5 Department of Nephrology, Chi-Mei Medical Center; Medical Laboratory Science & Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
6 Department of Rheumatology, Chi-Mei Medical Center, Tainan, Taiwan
7 Department of Neurological Surgery, Chi-Mei Medical Center, Tainan, Taiwan
8 Department of Neurology, Chi-Mei Medical Center; Institution of Biotechnology, Southern Taiwan University, Tainan, Taiwan
9 Institution of Healthcare, Chung Hwa University of Medical Technology, Tainan, Taiwan, Taiwan
Chung Hwa College of Medical Technology, Two 187 lanes, No. 12 of right way in the Rende, District of Tainan
Source of Support: None, Conflict of Interest: None
Background & objectives: Patients with prior stroke (PS) undergoing chronic dialysis are at a high risk of mortality. However, little is known about the cumulative risk and survival rate of dialysis patients with long-term follow up. The aim of this study was to assess risks for mortality between patients with and without PS undergoing chronic haemodialysis (HD).
Methods: The Taiwan National Health Insurance Research Database (NHRI-NHIRD-99182) was used and all adult patients (≥18 yr) with end stage renal disease (ESRD) who started maintenance HD between January 1, 1999, and December 31, 1999, were selected. The patients were followed from the first reported date of HD to the date of death, end of dialysis or December 31, 2008. A Cox's proportional hazard model was applied to identify the risk factors for all-cause mortality.
Results: Among 5672 HD patients, 650 patients (11.5%) had PS. A higher proportion of stroke history at baseline was found in men (52.8%) and those aged ≥ 55 yr (80.9%). After adjusting for age, sex and other covariates, the patients with PS were found to have a 36 per cent increased risk of mortality compared to those without PS (HR 1.36, 95% CI: 1.22-1.52). The cumulative survival rates among HD patients without PS were 96.0 per cent at the first year, 68.4 per cent at the fifth year, and 46.7 per cent at the ninth year, and 92.9, 47.3 and 23.6 per cent, respectively, in those with PS (log-rank: P<0.001).
Interpretation & conclusions: Our findings showed that PS was an important predictor for all-cause mortality and poor outcome in patients undergoing chronic HD.