Dataset Information

Risk of Stroke in Elderly Dialysis Patients.

ABSTRACT: Despite the current knowledge about the risk of stroke and its related factors in general population, this issue in elderly patients receiving dialysis remains unresolved. Firstly, to compare the risk of stroke between hemodialysis (HD) and peritoneal dialysis (PD), data on 13,065 incident dialysis patients (aged ≥ 65 years; 10,675 in HD and 2,390 in PD) were retrieved from the Korean Health Insurance dataset. Secondly, to identify the risk factors of stroke amongst various clinical and laboratory parameters in HD, 980 elderly patients were retrospectively analyzed using an independent prospective cohort from 31 dialysis centers. For a mean duration of 1.8 years (maximum of 5 years), the risk of all cardiovascular diseases (ischemic heart disease and stroke) did not differ between HD and PD. However, when analyses were conducted separately by subtype, the risk of stroke, not ischemic heart disease, was significantly higher in HD patients than in PD patients. When the risk factors of stroke were probed after HD for a mean duration of 2.6 years (maximum of 7 years), the absolute dependence on social support, a previous history of cardiovascular disease, high levels of low-density lipoprotein cholesterol, and the use of a high number of anti-hypertensive drugs were identified as being significant. Based on the discrepancy of stroke risk between modalities and the HD-tailored risk factors of stroke, the monitoring and management of these factors may be a key strategy to reduce the risk of stroke in elderly patients receiving dialysis.

SUBMITTER: Han SS

PROVIDER: S-EPMC5546965 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Risk of Stroke in Elderly Dialysis Patients.

Han Seung Seok SS Ryu Dong Ryeol DR Joo Kwon Wook KW Lim Chun Soo CS Kim Yong Lim YL Kang Shin Wook SW Kim Yon Su YS Kim Dong Ki DK

Journal of Korean medical science 20170901 9

Despite the current knowledge about the risk of stroke and its related factors in general population, this issue in elderly patients receiving dialysis remains unresolved. Firstly, to compare the risk of stroke between hemodialysis (HD) and peritoneal dialysis (PD), data on 13,065 incident dialysis patients (aged ≥ 65 years; 10,675 in HD and 2,390 in PD) were retrieved from the Korean Health Insurance dataset. Secondly, to identify the risk factors of stroke amongst various clinical and laborato ...[more]

PMID: 28776341

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Project description:BackgroundA shared decision-making tool could help elderly patients with advanced chronic kidney disease decide about initiating dialysis therapy. Because mortality may be high in the first few months after initiating dialysis therapy, incorporating early mortality predictors in such a tool would be important for an informed decision. Our objective is to derive and validate a predictive risk score for early mortality after initiating dialysis therapy.Study designRetrospective observational cohort, with development and validation cohorts.Setting & participantsUS Renal Data System and claims data from the Centers for Medicare & Medicaid Services for 69,441 (aged ≥67 years) patients with end-stage renal disease with a previous 2-year Medicare history who initiated dialysis therapy from January 1, 2009, to December 31, 2010.Candidate predictorsDemographics, predialysis care, laboratory data, functional limitations, and medical history.OutcomesAll-cause mortality in the first 3 and 6 months.Analytical approachPredicted mortality by logistic regression.ResultsThe simple risk score (total score, 0-9) included age (0-3 points), low albumin level, assistance with daily living, nursing home residence, cancer, heart failure, and hospitalization (1 point each), and showed area under the receiver operating characteristic curve (AUROC)=0.69 in the validation sample. A comprehensive risk score with additional predictors was also developed (with AUROC=0.72, high concordance between predicted vs observed risk). Mortality probabilities were estimated from these models, with the median score of 3 indicating 12% risk in 3 months and 20% in 6 months, and the highest scores (≥8) indicating 39% risk in 3 months and 55% in 6 months.LimitationsPatients who did not choose dialysis therapy and did not have a 2-year Medicare history were excluded.ConclusionsRoutinely available information can be used by patients with chronic kidney disease, families, and their nephrologists to estimate the risk of early mortality after dialysis therapy initiation, which may facilitate informed decision making regarding treatment options.

Project description:Background and objectivesA geriatric assessment is an appropriate method for identifying frail elderly patients. In CKD, it may contribute to optimize personalized care. However, a geriatric assessment is time consuming. The purpose of our study was to compare easy to apply frailty screening tools with the geriatric assessment in patients eligible for dialysis.Design, setting, participants, & measurementsA total of 123 patients on incident dialysis ≥65 years old were included <3 weeks before to ≤2 weeks after dialysis initiation, and all underwent a geriatric assessment. Patients with impairment in two or more geriatric domains on the geriatric assessment were considered frail. The diagnostic abilities of six frailty screening tools were compared with the geriatric assessment: the Fried Frailty Index, the Groningen Frailty Indicator, Geriatric8, the Identification of Seniors at Risk, the Hospital Safety Program, and the clinical judgment of the nephrologist. Outcome measures were sensitivity, specificity, positive predictive value, and negative predictive value.ResultsIn total, 75% of patients were frail according to the geriatric assessment. Sensitivity of frailty screening tools ranged from 48% (Fried Frailty Index) to 88% (Geriatric8). The discriminating features of the clinical judgment were comparable with the other screening tools. The Identification of Seniors at Risk screening tool had the best discriminating abilities, with a sensitivity of 74%, a specificity of 80%, a positive predictive value of 91%, and a negative predictive value of 52%. The negative predictive value was poor for all tools, which means that almost one half of the patients screened as fit (nonfrail) had two or more geriatric impairments on the geriatric assessment.ConclusionsAll frailty screening tools are able to detect geriatric impairment in elderly patients eligible for dialysis. However, all applied screening tools, including the judgment of the nephrologist, lack the discriminating abilities to adequately rule out frailty compared with a geriatric assessment.

Project description:Background and objectivesStroke is common in patients undergoing long-term dialysis, but the implications for mortality after stroke in these patients are not fully understood.Design, setting, participants, & measurementsA large cohort of dually-eligible (Medicare and Medicaid) patients initiating dialysis from 2000 to 2005 and surviving the first 90 days was constructed. Medicare claims were used to ascertain ischemic and hemorrhagic strokes occurring after 90-day survival. A semi-Markov model with additive hazard extension was generated to estimate the association between stroke and mortality, to calculate years of life lost after a stroke, and to determine whether race was associated with differential survival after stroke.ResultsThe cohort consisted of 69,371 individuals representing >112,000 person-years of follow-up. Mean age±SD was 60.8±15.5 years. There were 21.1 (99% confidence interval [99% CI], 20.0 to 22.3) ischemic strokes and 4.7 (99% CI, 4.2 to 5.3) hemorrhagic strokes after cohort entry per 1000 patient-years. At 30 days, mortality was 17.9% for ischemic stroke and 53.4% for hemorrhagic stroke. The adjusted hazard ratio (AHR) depended on time since entry into the cohort; for patients who experienced a stroke at 1 year after cohort entry, for example, the AHR of hemorrhagic stroke for mortality was 25.4 (99% CI, 22.4 to 28.4) at 1 week, 9.9 (99% CI, 8.4 to 11.6) at 3 months, 5.9 (99% CI, 5.0 to 7.0) at 6 months, and 1.8 (99% CI, 1.5 to 2.1) at 24 months. The corresponding AHRs for ischemic stroke were 11.7 (99% CI, 10.2 to 13.1) at 1 week, 6.6 (99% CI, 6.4 to 6.7) at 3 months, and 4.7 (99% CI, 4.5 to 4.9) at 6 months, remaining significantly >1.0 even at 48 months. Median months of life lost were 40.7 for hemorrhagic stroke and 34.6 for ischemic stroke. For both stroke types, mortality did not differ by race.ConclusionsDialysis recipients have high mortality after a stroke with corresponding decrements in remaining years of life. Poststroke mortality does not differ by race.

Project description:Objective The study aims to systematically evaluate the risk factors of pulmonary infection in elderly patients with acute stroke. Methods PubMed, CENTRAL, CINAHL, Web of Science, Embase, and four Chinese databases (CNKI, SinoMed, VIP, and Wanfang databases) for studies involving risk factors of pulmonary infection in elderly patients with acute stroke were searched. Then, two researchers independently read the article titles and abstracts to screen the literature, extracted relevant research data, and evaluated the methodological quality. Finally, a meta-analysis was performed. Results In total, fifteen studies were included, with medium and high-grade quality. Meta-analysis results showed: age [OR = 1.70, 95% CI (1.27, 2.29), P = 0.0004], type of stroke [OR = 1.30, 95% CI (1.21, 1.40), P < 0.00001], conscious disturbance [OR = 2.27, 95% CI (1.44, 3.58), P = 0.0004], dysphagia [OR = 3.24, 95% CI (2.06, 5.12), P < 0.00001], diabetes mellitus [OR = 2.35, 95% CI (1.23, 4.48), P = 0.010], hypertension [OR = 2.05, 95% CI (1.83, 2.31), P < 0.0001], chronic obstructive pulmonary disease (COPD) [OR = 2.69, 95% CI (1.90, 3.81), P < 0.00001], hyperlipidemia [OR = 1.29, 95% CI (1.19, 1.39), P < 0.00001], invasive procedure [OR = 3.37, 95% CI (2.30, 4.94), P < 0.00001], hospital stays [OR = 1.41, 95% CI (1.22, 1.62), P < 0.00001], bedridden time [OR = 1.51, 95% CI (1.36, 1.68), P < 0.00001], and National Institute of Health Stroke Scale (NIHSS) score [OR = 1.67, 95% CI (1.02, 2.75), P = 0.04] were independent risk factors. Glasgow Coma Scale (GCS) score was not a risk factor. However, the relationship between atrial fibrillation, smoking history, and pulmonary infection in elderly patients with acute stroke needs further proof. Conclusions Age, type of stroke, conscious disturbance, dysphagia, diabetes mellitus, hypertension, COPD, hyperlipidemia, invasive procedure, hospital stays, bedridden time, and NIHSS score were risk factors for pulmonary infection in elderly patients with acute stroke. Elderly patients; Acute stroke; Pulmonary infection; Risk factors; Meta-analysis.

Dataset Information

Risk of Stroke in Elderly Dialysis Patients.

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Risk of Stroke in Elderly Dialysis Patients.

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