2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Seliger, S. L. Articles by Stehman-Breen, C. O. Search for Related Content PubMed PubMed Citation Articles by Seliger, S. L. Articles by Stehman-Breen, C. O.

Risk Factors for Incident Stroke among Patients with End-Stage Renal Disease

Stephen L. Seliger^*, Daniel L. Gillen, David Tirschwell, Haimanot Wasse^*, Bryan R. Kestenbaum^* and Catherine O. Stehman-Breen

*Division of Nephrology, University of Washington, Seattle, Washington; Department of Biostatistics, University of Washington School of Public Health and Community Medicine, Seattle, Washington; Department of Neurology, University of Washington, Seattle, Washington; and Division of Nephrology, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington

Correspondence to Dr. Stephen L. Seliger, Division of Nephrology, Box 356521, University of Washington, Seattle, WA 98102. Phone: 206-543-3792; Fax: 206-685-8661;

ABSTRACT. Although patients with ESRD experience markedly higher rates of stroke, no studies in the US have identified risk factors associated with stroke in this population. It was hypothesized that black race, malnutrition, and elevated BP would be associated with the risk of stroke among patients with ESRD. Data from the United States Renal Data Systems were used. Adult Medicare-insured hemodialysis and peritoneal dialysis patients without a history of stroke or transient ischemic attack (TIA) were considered for analysis. The primary outcome was hospitalized or fatal stroke. Cox proportional hazards models were used to determine the associations between the primary predictor variables and stroke. The rate of incident stroke was 33/1,000 person-years in the study sample. After adjustment for age and other patient characteristics, three markers of malnutrition were associated with the risk of stroke—serum albumin (per 1 g/dl decrease, hazard ratio [HR] = 1.43), height-adjusted body weight (per 25% decrease, HR = 1.09), and a subjective assessment of undernourishment (HR = 1.27)—as was higher mean BP (per 10 mmHg, HR = 1.11). The association between black race varied by cardiac disease status, with blacks estimated to be at lower risk than whites among individuals with cardiac disease (HR = 0.74), but at higher risk among individuals without cardiac disease (HR = 1.24). This study confirms the extraordinarily high rates of stroke in ESRD patients on dialysis and identifies high mean BP and malnutrition as potentially modifiable risk factors. The association between black race and stroke differs by cardiac disease status; the reasons for this differing effect of race deserve further investigation. E-mail: seliger@u.washington.edu

This article has been cited by other articles:

				K. L. Lentine, L. A. R. Rey, S. Kolli, G. Bacchi, M. A. Schnitzler, K. C. Abbott, H. Xiao, and D. C. Brennan Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1090 - 1101. [Abstract] [Full Text] [PDF]

				A. M. Murray, D. E. Tupper, D. S. Knopman, D. T. Gilbertson, S. L. Pederson, S. Li, G. E. Smith, A. K. Hochhalter, A. J. Collins, and R. L. Kane Cognitive impairment in hemodialysis patients is common. Neurology, July 25, 2006; 67(2): 216 - 223. [Abstract] [Full Text] [PDF]

				A. S. Goldfarb-Rumyantzev, B. C. Baird, J. K. Leypoldt, and A. K. Cheung The association between BP and mortality in patients on chronic peritoneal dialysis Nephrol. Dial. Transplant., August 1, 2005; 20(8): 1693 - 1701. [Abstract] [Full Text] [PDF]

				S. Bro, F. Moeller, C. B. Andersen, K. Olgaard, and L. B. Nielsen Increased Expression of Adhesion Molecules in Uremic Atherosclerosis in Apolipoprotein-E-Deficient Mice J. Am. Soc. Nephrol., June 1, 2004; 15(6): 1495 - 1503. [Abstract] [Full Text] [PDF]

				S. Beddhu, L. M. Pappas, N. Ramkumar, and M. H. Samore Malnutrition and Atherosclerosis in Dialysis Patients J. Am. Soc. Nephrol., March 1, 2004; 15(3): 733 - 742. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673