TREND IN INCIDENT RISK OF ISCHEMIC STROKE AMONG INDIVIDUALS ON MAINTENANCE DIALYSIS IN ALBERTA, CANADA

Introduction:

Kidney failure inherently increases the risk of cardiovascular diseases, including stroke. Dialysis, particularly when it disrupts hemodynamics, further elevates stroke risk, contributing to significant morbidity and mortality. We evaluated the trend in stroke burden and identify associated factors among individuals undergoing dialysis in Alberta.

Methods:

A retrospective cohort study included individuals aged ≥18 years in Alberta, Canada, who initiated maintenance dialysis between January 1, 2010, and March 31, 2019. Participants were categorized at baseline on their initial dialysis modality: hemodialysis (HD) or peritoneal dialysis (PD The primary outcome was the annual rate of acute ischemic stroke, including recurrent events. Acute ischemic stroke was identified using ICD-10 diagnosis codes. We utilized zero inflated negative binomial model with log link to analyze and identify the secular trend of the annual rate of acute ischemic stroke from 2010 to 2021. We used the cluster sandwich estimator to account for the inter-cluster correlation in the repeated annual rate measurements within individual. The fully adjusted models included terms for age, sex, deprivation index, location of residency, and key clinical variables linked to the outcomes of interest.

Results:

We had 5,538 participants, including 4,297 on HD and 1,241 on PD, with a mean age of 62.4 years and 63% male. The median follow-up period was 4.1 years. Common comorbidities were hypertension (88.5%), diabetes (59%), coronary artery disease (41%), and heart failure (38%). The adjusted incidence rates of acute ischemic stroke increased from 1.85 to 2.63 per 100 person-years for HD patients and from 1.8 to 3.18 for PD patients between 2010 and 2021. There was a small but non-statistically significant increase in stroke incidence for both HD and PD groups (HD: incident risk ratio (IRR) 1.03, 95% CI 0.97-1.10, P=0.302; PD: IRR 1.05, 95% CI 0.95-1.16, P=0.308) (Figure 1). Significant risk factors for acute ischemic stroke included age, urban residence, diabetes, cardiovascular diseases, cancer, depression, cirrhosis, chronic pulmonary disease, dementia, and schizophrenia.

Conclusions:

This study shows a rising trend (albeit non-statistically significant) in the incidence of acute ischemic stroke among patients undergoing chronic dialysis. Further work at understanding the potential exploratory risk factors for ischemic stroke in dialysis population is warranted, and will help to define appropriate prevention strategies.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.