Relationship between history of ischemic stroke and all-cause mortality in incident dialysis patients

Masayasu Kojima, Daijo Inaguma, Shigehisa Koide, Eri Koshi-Ito, Kazuo Takahashi, Hiroki Hayashi, Naotake Tsuboi, Midori Hasegawa, Yukio Yuzawa

Research output: Contribution to journalArticle

Abstract

Background: Few studies have focused on the association between history of ischemic stroke at predialysis stage and mortality after dialysis initiation. Objective: To examine whether history of stroke in incident dialysis patients is associated with mortality, including all-cause and cardiovascular (CV)-related mortality. Methods: The study database was derived from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis, a multicenter, prospective, cohort analysis. We classified patients into 2 groups according to their history of ischemic stroke and compared their outcomes. Propensity scores (PSs) represented the probability of being assigned to a group with or without a history of ischemic stroke. We defined the following outcomes: All-cause mortality; CV-related mortality; non-CV-related mortality; infection-related mortality; and stroke event after dialysis initiation. Factors contributing to the outcomes were examined using stepwise multivariate Cox proportional hazards analysis. Results: All-cause mortality was significantly higher in the ischemic stroke group (log-rank test p < 0.001). All-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation were significantly higher in the ischemic stroke group after PS matching (log-rank test: P < 0.001, <0.001, 0.002, and 0.002, respectively). History of ischemic stroke was associated with all-cause mortality in univariate analysis (hazard ratio [HR] 1.85, 95% CI 1.44-2.37). History of ischemic stroke before dialysis initiation was associated with all-cause mortality in multivariate analysis (HR 1.39, 95% CI 1.05-1.85). Conclusion: The present study revealed that history of ischemic stroke before dialysis initiation was associated with all-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation during maintenance dialysis.

Original languageEnglish
Pages (from-to)43-53
Number of pages11
JournalNephron
Volume143
Issue number1
DOIs
Publication statusPublished - 01-09-2019

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Dialysis
Stroke
Mortality
Propensity Score
Cohort Studies
Infection
Multivariate Analysis
Maintenance
Databases

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Urology
  • Physiology (medical)

Cite this

Kojima, Masayasu ; Inaguma, Daijo ; Koide, Shigehisa ; Koshi-Ito, Eri ; Takahashi, Kazuo ; Hayashi, Hiroki ; Tsuboi, Naotake ; Hasegawa, Midori ; Yuzawa, Yukio. / Relationship between history of ischemic stroke and all-cause mortality in incident dialysis patients. In: Nephron. 2019 ; Vol. 143, No. 1. pp. 43-53.
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abstract = "Background: Few studies have focused on the association between history of ischemic stroke at predialysis stage and mortality after dialysis initiation. Objective: To examine whether history of stroke in incident dialysis patients is associated with mortality, including all-cause and cardiovascular (CV)-related mortality. Methods: The study database was derived from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis, a multicenter, prospective, cohort analysis. We classified patients into 2 groups according to their history of ischemic stroke and compared their outcomes. Propensity scores (PSs) represented the probability of being assigned to a group with or without a history of ischemic stroke. We defined the following outcomes: All-cause mortality; CV-related mortality; non-CV-related mortality; infection-related mortality; and stroke event after dialysis initiation. Factors contributing to the outcomes were examined using stepwise multivariate Cox proportional hazards analysis. Results: All-cause mortality was significantly higher in the ischemic stroke group (log-rank test p < 0.001). All-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation were significantly higher in the ischemic stroke group after PS matching (log-rank test: P < 0.001, <0.001, 0.002, and 0.002, respectively). History of ischemic stroke was associated with all-cause mortality in univariate analysis (hazard ratio [HR] 1.85, 95{\%} CI 1.44-2.37). History of ischemic stroke before dialysis initiation was associated with all-cause mortality in multivariate analysis (HR 1.39, 95{\%} CI 1.05-1.85). Conclusion: The present study revealed that history of ischemic stroke before dialysis initiation was associated with all-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation during maintenance dialysis.",
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Relationship between history of ischemic stroke and all-cause mortality in incident dialysis patients. / Kojima, Masayasu; Inaguma, Daijo; Koide, Shigehisa; Koshi-Ito, Eri; Takahashi, Kazuo; Hayashi, Hiroki; Tsuboi, Naotake; Hasegawa, Midori; Yuzawa, Yukio.

In: Nephron, Vol. 143, No. 1, 01.09.2019, p. 43-53.

Research output: Contribution to journalArticle

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T1 - Relationship between history of ischemic stroke and all-cause mortality in incident dialysis patients

AU - Kojima, Masayasu

AU - Inaguma, Daijo

AU - Koide, Shigehisa

AU - Koshi-Ito, Eri

AU - Takahashi, Kazuo

AU - Hayashi, Hiroki

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AU - Hasegawa, Midori

AU - Yuzawa, Yukio

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N2 - Background: Few studies have focused on the association between history of ischemic stroke at predialysis stage and mortality after dialysis initiation. Objective: To examine whether history of stroke in incident dialysis patients is associated with mortality, including all-cause and cardiovascular (CV)-related mortality. Methods: The study database was derived from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis, a multicenter, prospective, cohort analysis. We classified patients into 2 groups according to their history of ischemic stroke and compared their outcomes. Propensity scores (PSs) represented the probability of being assigned to a group with or without a history of ischemic stroke. We defined the following outcomes: All-cause mortality; CV-related mortality; non-CV-related mortality; infection-related mortality; and stroke event after dialysis initiation. Factors contributing to the outcomes were examined using stepwise multivariate Cox proportional hazards analysis. Results: All-cause mortality was significantly higher in the ischemic stroke group (log-rank test p < 0.001). All-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation were significantly higher in the ischemic stroke group after PS matching (log-rank test: P < 0.001, <0.001, 0.002, and 0.002, respectively). History of ischemic stroke was associated with all-cause mortality in univariate analysis (hazard ratio [HR] 1.85, 95% CI 1.44-2.37). History of ischemic stroke before dialysis initiation was associated with all-cause mortality in multivariate analysis (HR 1.39, 95% CI 1.05-1.85). Conclusion: The present study revealed that history of ischemic stroke before dialysis initiation was associated with all-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation during maintenance dialysis.

AB - Background: Few studies have focused on the association between history of ischemic stroke at predialysis stage and mortality after dialysis initiation. Objective: To examine whether history of stroke in incident dialysis patients is associated with mortality, including all-cause and cardiovascular (CV)-related mortality. Methods: The study database was derived from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis, a multicenter, prospective, cohort analysis. We classified patients into 2 groups according to their history of ischemic stroke and compared their outcomes. Propensity scores (PSs) represented the probability of being assigned to a group with or without a history of ischemic stroke. We defined the following outcomes: All-cause mortality; CV-related mortality; non-CV-related mortality; infection-related mortality; and stroke event after dialysis initiation. Factors contributing to the outcomes were examined using stepwise multivariate Cox proportional hazards analysis. Results: All-cause mortality was significantly higher in the ischemic stroke group (log-rank test p < 0.001). All-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation were significantly higher in the ischemic stroke group after PS matching (log-rank test: P < 0.001, <0.001, 0.002, and 0.002, respectively). History of ischemic stroke was associated with all-cause mortality in univariate analysis (hazard ratio [HR] 1.85, 95% CI 1.44-2.37). History of ischemic stroke before dialysis initiation was associated with all-cause mortality in multivariate analysis (HR 1.39, 95% CI 1.05-1.85). Conclusion: The present study revealed that history of ischemic stroke before dialysis initiation was associated with all-cause, non-CV-related, and infection-related mortality and stroke event after dialysis initiation during maintenance dialysis.

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