Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke

Abstract

BackgroundThere is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis.Methods and ResultsWe 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 (P trend<0.001), while it remained stable in non‐dialysis patients (P trend=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 (P trend<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.ConclusionsDialysis 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.

Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

“…Utilization of gastrostomy (5.6%) and mechanical ventilation (2.8%) was also increased owing to stroke related complications. 34 ESRD patients especially on HD are at an increased risk of bleeding especially upper gastrointestinal (GI) bleeding secondary to angiodysplasia and erosive esophagitis. 35 It can also be due to other causes such as, arteriovenous access related, oral/ nasal or genitourinary bleeding.…”

Repeated mechanical thrombectomy for acute ischemic stroke in a dialysis patient: A case report and literature review

“…1,2 Large vessel occlusion (LVO) is the most severe type of ischemic stroke, with the highest disability and mortality. 1,2 Large vessel occlusion (LVO) is the most severe type of ischemic stroke, with the highest disability and mortality.…”

“…Patients with end-stage renal disease undergoing maintenance dialysis have a higher incidence of both ischemic and hemorrhagic stroke than the general population. 1,2 Large vessel occlusion (LVO) is the most severe type of ischemic stroke, with the highest disability and mortality. Mechanical thrombectomy (MT) combined with optimal medical management leads to significantly better outcomes and has become the standard care for acute ischemic stroke (AIS) patients with LVO.…”

Repeated Mechanical Thrombectomy of Recurrent Large Vessel Occlusion: Case Report and Brief Review of the Literature

“…In addition, for LVO recurring in the short term, it is possible to perform repeated MTs [3]. However, patients with end-stage renal disease undergoing maintenance dialysis have a higher incidence of both ischemic and hemorrhagic stroke than the general population [4,5], there have been no reports of repeated MT for LVO patients with dialysis.…”