Outcomes Following Ischemic Stroke in Older Patients With CKD Stages 4 and 5: A Retrospective Cohort Study.
Outcomes Following Ischemic Stroke in Older Patients With CKD Stages 4 and 5: A Retrospective Cohort Study.
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DOI：
10.1053/j.ajkd.2020.03.021
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Kasner SE
中科院分区：
文献类型：
--
作者：
Wetmore JB;Herzog CA;Sexter A;Gilbertson DT;Liu J;Kasner SE
成人晚期慢性肾脏疾病（CKD）患者缺血性卒中与透析起始时间和/或死亡之间的关系尚未探讨。我们试图测量CKD4期和5期（CKD4-5）卒中的发生率和相关因素，并评估卒中与开始透析和死亡的关系。回顾性队列。2007 - 2014年Medicare中ckd2 - 5患者。CKD4-5缺血性卒中。开始维持性透析或死亡。Cox比例风险模型评估与缺血性卒中相关的因素。一项匹配分析（卒中/非卒中）估计了作为竞争事件的肾衰竭和死亡的累积发生率。使用状态转移模型的模拟确定了CKD5卒中患者和非卒中患者到肾衰竭或死亡和单独死亡的预期时间的差异。确定了123,251例CKD4患者和22054例CKD5患者。平均年龄分别为81.0岁和79.2岁。女性（CKD4和CKD5的hr分别为1.21 [95% CI, 1.12 - 1.31]和1.39 [95% CI, 1.04-1.86]）和黑人（CKD4和CKD5的hr分别为1.25 [95% CI, 1.12 - 1.39]和1.12 [95% CI, 0.80-1.58]）是缺血性卒中的相关因素。30天死亡率分别为13.3%和18.8%，1年死亡率分别为40.0%和38.2%。对于CKD5患者，缺血性中风患者的肾功能衰竭或死亡平均提前3.6个月，死亡（不考虑肾功能衰竭）平均提前24.3个月。研究设计不能确定因果关系；缺乏中风严重程度的数据。女性和黑人种族与CKD4和CKD5患者中风风险增加有关。在CKD5中，中风与肾衰竭或死亡的时间缩短了近4个月，与死亡的时间缩短了2年以上。
The associations between ischemic stroke and time to dialysis initiation and/or death in adults with late-stage chronic kidney disease (CKD) have not been explored. We sought to measure the rate and factors associated with stroke in CKD stages 4 and 5 (CKD4–5) and assess the association of stroke with initiation of dialysis and death. Retrospective cohort. Patients with CKD4–5 in Medicare 2007 to 2014. Ischemic stroke in CKD4–5. Initiation of maintenance dialysis or death. Cox proportional hazard modeling assessed factors associated with ischemic stroke. A matched analysis (stroke/no stroke) estimated the cumulative incidence of incident kidney failure and death, treated as competing events. Simulations using a state transition model determined differences in expected time to kidney failure or death and death alone for patients with and without stroke with CKD5. 123,251 patients with CKD4 and 22,054 with CKD5 were identified. Mean ages were 81.0 and 79.2 years, respectively. Female sex (HRs of 1.21 [95% CI, 1.12–1.31] and 1.39 [95% CI, 1.04–1.86] for CKD4 and CKD5, respectively) and black race (HRs of 1.25 [95% CI, 1.12–1.39] and 1.12 [95% CI, 0.80–1.58] for CKD4 and CKD5, respectively) were factors associated with ischemic stroke. Rates for 30-day mortality were 13.3% and 18.8%, and for 1-year mortality, 40.0% and 38.2%. For patients with CKD5, kidney failure or death occurred an average of 3.6 months sooner for patients with an ischemic stroke, and death (irrespective of kidney failure), a mean of 24.3 months sooner. Study design cannot determine causality; lack of data for stroke severity. Female sex and black race were associated with increased risk for stroke in CKD4 and CKD5. In CKD5, stroke was associated with a shorter time to kidney failure or death by nearly 4 months, and to death, by more than 2 years.
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影响因子：
168.9
作者：
Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
影响因子：
8.3
作者：
Howard G;Cushman M;Kissela BM;Kleindorfer DO;McClure LA;Safford MM;Rhodes JD;Soliman EZ;Moy CS;Judd SE;Howard VJ;REasons for Geographic And Racial Differences in Stroke (REGARDS) Investigators
通讯作者：
REasons for Geographic And Racial Differences in Stroke (REGARDS) Investigators
影响因子：
13.6
作者：
Wetmore, James B.;Ellerbeck, Edward F.;Shireman, Theresa I.
通讯作者：
Shireman, Theresa I.
影响因子：
13.2
作者：
Power, Albert;Chan, Kakit;Duncan, Neill
通讯作者：
Duncan, Neill
影响因子：
13.2
作者：
Wetmore, James B.;Yan, Heng;Liu, Jiannong
通讯作者：
Liu, Jiannong