National Study of Acute Stroke in Patients on Renal Replacement Therapies

Background: Stroke in patients on renal replacement therapy [RRT] remains poorly studied especially in peritoneal dialysis [PD] & transplant cohorts and particularly in Europe. We therefore conducted a national study to characterize the distribution and impact of stroke in all RRT patients. Methods: We studied all patients incident to RRT in England [Jan 2002–Dec 2006] with follow up to Dec 2009 [n=21175, 62% male, 47% diabetic, 74% hemodialysis, 23% PD]. Demography & comorbidity at the start of RRT and hospitalization for first acute stroke were derived from ICD-10 codes in national Hospital Episode Statistic [HES] datasets linked to UK Renal Registry data. Results: Overall 12% of the study cohort [n=2484] experienced fi rst acute stroke [40% events prior to RRT start] compared to 2.3% in the general population. During RRT, 77% strokes occurred in hemodialysis [HD], 16% on PD & 4% in renal transplant patients. Acute stroke patients were older [mean 65.9 vs 60.3yrs, p<0.001] with 62% strokes clustering in those >65yrs old. Stroke associated with cardiac & peripheral arterial disease [p<0.001], diabetes [p<0.001], and especially prior cerebrovascular disease [51% vs 7%, p<0.001]. There was no association between stroke and ethnicity [p=0.5], health network area [p=0.6] or social deprivation [Townsend index, p=0.1] with a trend to more events in females [p=0.08] in keeping with UK population data. Conclusions: Stroke affects a signifi cant proportion of patients on all RRT modalities and remains over-represented in dialysis cohorts particularly HD. Current ongoing analyses of national patient- & treatment-level stroke risk factors will allow for interventions to reduce stroke burden in all RRT populations.