Key result
End-stage renal disease in stroke patients was associated with a higher death rate during admission (22.9% vs 14.4% for dialysis; P=0.002), though stroke unit care lowered mortality risk (HR 0.68).
Why the study?
Does ESRD status affect the quality of acute stroke care and mortality, and does admission to a stroke unit improve survival in ESRD patients with stroke?
Cohort (n=70,124)
Yes
Does ESRD status affect the quality of acute stroke care and mortality, and does admission to a stroke unit improve survival in ESRD patients with stroke?
Stroke patients with ESRD receive suboptimal acute stroke care and have higher mortality, but admission to a dedicated stroke unit significantly improves their survival.
ESRD stroke patients had higher in-hospital mortality; stroke unit care was associated with lower risk but needs prospective confirmation.
Introduction Stroke rate and mortality are greater in individuals with end-stage renal disease (ESRD) than in those without ESRD. We examined discrepancies in stroke care in ESRD patients and their influence on mortality. Methods This is a national record linkage cohort study of hospitalized stroke individuals from 2005 to 2013. Presentation, measures of care quality (admission to stroke unit, swallow assessment, antithrombotics, or thrombolysis use), and outcomes were compared in those with and without ESRD after propensity score matching (PSM). We examined the effect of being admitted to a stroke unit on survival using Kaplan-Meier and Cox survival analyses. Results A total of 8757 individuals with ESRD and 61,367 individuals with stroke were identified. ESRD patients (n =486) experienced stroke over 34,551.9 patient-years of follow-up; incidence rates were 25.3 (dialysis) and 4.5 (kidney transplant)/1000 patient-years. After PSM, dialysis patients were less likely to be functionally independent (61.4% vs. 77.7%; P < 0.0001) before stroke, less frequently admitted to stroke units (64.6% vs. 79.6%; P < 0.001), or to receive aspirin (75.3% vs. 83.2%; P = 0.01) than non-ESRD stroke patients. There were no significant differences in management of kidney transplantation patients. Stroke with ESRD was associated with a higher death rate during admission (dialysis 22.9% vs.14.4%, P = 0.002; transplantation: 19.6% vs. 9.3%; P = 0.034). Managing ESRD patients in a stroke unit was associated with a lower risk of death at follow-up (hazard ratio: 0.68; 95% confidence interval: 0.55−0.84). Conclusion Stroke incidence is high in ESRD. Individuals on dialysis are functionally more dependent before stroke and less frequently receive optimal stroke care. After a stroke, death is more likely in ESRD patients. Acute stroke unit care may be associated with lower mortality.
No takes yet. Share an insight, caveat, or question.
Findlay et al. (2018) conducted a cohort in Stroke and End-Stage Renal Disease (n=70,124). End-stage renal disease (ESRD) vs. No ESRD was evaluated on Death rate during admission (dialysis vs non-ESRD) (p=0.002). End-stage renal disease in stroke patients was associated with a higher death rate during admission (22.9% vs 14.4% for dialysis; P=0.002), though stroke unit care lowered mortality risk (HR 0.68).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: