Risk of Cerebral Infarction in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study (MID study)

Abstract

Background/Aims: Predictors including the preventive effects of antiplatelet and anticoagulant drugs on cerebral infarction (CI) events have not yet been clarified in dialysis patients. The aim of the present study was to examine the risk of CI and preventive effects of these drugs in Japanese hemodialysis patients. Methods: Patients receiving maintenance hemodialysis (n=1,551, median age (interquartile range), 69.0 (59.0-78.0) years; 41.5% female) were enrolled in the Miyazaki Dialysis Cohort Study and prospectively followed-up for 3 years. Kaplan-Meier and Cox's regression analyses were used to clarify the risk of CI. Results: Eighty-four patients developed CI at an incidence of 21.5/1000 patients per year. The presence of a previous history of CI, atrial fibrillation (AF), and diabetes mellitus in addition to age were also identified as predictive factors for new CI, whereas no relationship was observed between antiplatelet and/or anticoagulant usage and CI. Furthermore, no significant difference was noted in the frequency of CI events between patients with AF who received warfarin and those who did not. Conclusions: The incidence of CI was higher in dialysis patients with a previous history of CI and AF; however, the preventive effects of antiplatelet/anticoagulant drugs on the development of CI were not evident.

Is anticoagulating haemodialysis patients with non‐valvular atrial fibrillation too risky?

“…One study found the incidence of ischaemic stroke was 10·6% with haemorrhagic type being 2·6% (Wang et al , ). The incidence of stroke in chronic haemodialysis patients has been reported to be 3·78/100 patient‐years (Wiesholzer et al , ) with similar reports in other studies (Findlay et al , ; Shih et al , ; Toida et al , ). In one study 11·6% of patients experienced a stroke and 95% of these were ischaemic.…”

“…However, their findings suggested the magnitude of AF with subsequent stroke in haemodialysis patients was notably less than that reported in the general population. Toida et al () also found similar results, with cerebrovascular infarction events being significantly more common in patients with AF than in those without. The meta‐analyses by Zimmerman et al () found that the stroke rate was increased in patients with AF, at 5·2/100 patient‐years compared with 1·9/100 patient‐years in those without AF.…”

Initial report of percutaneous left atrial appendage closure in hemodialysis patients with atrial fibrillation and high risk of bleeding in Japan

“…In non-hemodialysis patients, the existence of NVAF is a major trigger of cardiac stroke. The hemodialysis patients have multiple high-risk origins of thromboembolic strokes due to systemic atherosclerosis, whereas cardiac stroke is reported to be a major etiology in Japan [ 15 ].…”

The Association of Atrial Fibrillation and Ischemic Stroke in Patients on Hemodialysis: A Competing Risk Analysis

“…14 However, the bleeding risk associated with anticoagulation is much higher in the ESRD population than that observed in patients without ESRD 15 and the less frequently acknowledged complications of warfarin are of greater significance in patients with ESRD, specifically accelerated vascular calcification, 16 and calciphylaxis. 17 Reports on the effects of AF are inconsistent - potentially because despite the increasing number of publications examining the factors associated with stroke, 18-33 most fail to address an important issue of survival analysis—the concept of a competing risk. Briefly, a competing risk is an event that occurs during follow-up which forever prevents the event of interest occurring.…”