Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke
Background There is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis. Methods and Results We used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of...
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| Format: | Article |
| Language: | English |
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Wiley
2018-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008686 |
| _version_ | 1811328942699708416 |
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| author | Fahad Alqahtani Chalak O. Berzingi Sami Aljohani Mohamed Al Hajji Anas Diab Muhammad Alvi Khaled Boobes Mohamad Alkhouli |
| author_facet | Fahad Alqahtani Chalak O. Berzingi Sami Aljohani Mohamed Al Hajji Anas Diab Muhammad Alvi Khaled Boobes Mohamad Alkhouli |
| author_sort | Fahad Alqahtani |
| collection | DOAJ |
| description | Background There is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis. Methods and Results We used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of AIS in dialysis patients. A total of 930 010 patients were admitted with AIS between 2003 and 2014, of whom 13 642 (1.5%) were on dialysis. Overall, the incidence of AIS among dialysis patients decreased significantly (Ptrend<0.001), while it remained stable in non‐dialysis patients (Ptrend=0.78). Compared with non‐dialysis patients, those on dialysis were younger (67±13 years versus 71±15 years, P<0.001), and had higher prevalence of major comorbidities. Black patients constituted 35.2% of dialysis patients admitted with AIS compared with 16.7% of patients in the non‐dialysis group (P<0.001). After propensity score matching, in‐hospital mortality was higher in the dialysis group (7.6% versus 5.2%, P<0.001), but this mortality gap narrowed overtime (Ptrend<0.001). Hemorrhagic conversion and gastrointestinal bleeding rates were similar, but blood transfusion was more common in the dialysis group. Rates of severe disability surrogates (tracheostomy, gastrostomy, mechanical ventilation and non‐home discharge) were also similar in both groups. However, dialysis patients had longer hospitalizations, and accrued a 25% higher total cost of acute care. Conclusions Dialysis patients have 8‐folds higher incidence of AIS compared withnon‐dialysis patients. They also have higher risk‐adjusted in‐hospital mortality, sepsis and blood transfusion, longer hospitalizations, and higher cost. There is a need to identify preventative strategies to reduce the risk of AIS in the dialysis population. |
| first_indexed | 2024-04-13T15:34:59Z |
| format | Article |
| id | doaj.art-04ccd9c503644523acdadd6a1a683801 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T15:34:59Z |
| publishDate | 2018-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-04ccd9c503644523acdadd6a1a6838012022-12-22T02:41:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-06-0171210.1161/JAHA.118.008686Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic StrokeFahad Alqahtani0Chalak O. Berzingi1Sami Aljohani2Mohamed Al Hajji3Anas Diab4Muhammad Alvi5Khaled Boobes6Mohamad Alkhouli7Division of Cardiology Department of Medicine West Virginia University School of Medicine Morgantown WVDivision of Cardiology Department of Medicine West Virginia University School of Medicine Morgantown WVDivision of Cardiology Department of Medicine West Virginia University School of Medicine Morgantown WVDivision of Cardiology Department of Medicine West Virginia University School of Medicine Morgantown WVDivision of Nephrology Department of Medicine West Virginia University School of Medicine Morgantown WVDepartment of Neurology Department of Medicine West Virginia University School of Medicine Morgantown WVDivision of Nephrology Department of Medicine Ohio State University Columbus OhioDivision of Cardiology Department of Medicine West Virginia University School of Medicine Morgantown WVBackground There is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis. Methods and Results We used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of AIS in dialysis patients. A total of 930 010 patients were admitted with AIS between 2003 and 2014, of whom 13 642 (1.5%) were on dialysis. Overall, the incidence of AIS among dialysis patients decreased significantly (Ptrend<0.001), while it remained stable in non‐dialysis patients (Ptrend=0.78). Compared with non‐dialysis patients, those on dialysis were younger (67±13 years versus 71±15 years, P<0.001), and had higher prevalence of major comorbidities. Black patients constituted 35.2% of dialysis patients admitted with AIS compared with 16.7% of patients in the non‐dialysis group (P<0.001). After propensity score matching, in‐hospital mortality was higher in the dialysis group (7.6% versus 5.2%, P<0.001), but this mortality gap narrowed overtime (Ptrend<0.001). Hemorrhagic conversion and gastrointestinal bleeding rates were similar, but blood transfusion was more common in the dialysis group. Rates of severe disability surrogates (tracheostomy, gastrostomy, mechanical ventilation and non‐home discharge) were also similar in both groups. However, dialysis patients had longer hospitalizations, and accrued a 25% higher total cost of acute care. Conclusions Dialysis patients have 8‐folds higher incidence of AIS compared withnon‐dialysis patients. They also have higher risk‐adjusted in‐hospital mortality, sepsis and blood transfusion, longer hospitalizations, and higher cost. There is a need to identify preventative strategies to reduce the risk of AIS in the dialysis population.https://www.ahajournals.org/doi/10.1161/JAHA.118.008686dialysisend stage renal diseaseischemic stroke |
| spellingShingle | Fahad Alqahtani Chalak O. Berzingi Sami Aljohani Mohamed Al Hajji Anas Diab Muhammad Alvi Khaled Boobes Mohamad Alkhouli Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease dialysis end stage renal disease ischemic stroke |
| title | Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke |
| title_full | Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke |
| title_fullStr | Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke |
| title_full_unstemmed | Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke |
| title_short | Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke |
| title_sort | temporal trends in the outcomes of dialysis patients admitted with acute ischemic stroke |
| topic | dialysis end stage renal disease ischemic stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008686 |
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