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Impact of dialysis modality on the survival of patients with end-stage renal disease and prior stroke

  • Nephrology - Original Paper
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Abstract

Purpose

Of patients with end-stage renal disease (ESRD), 8–16 % had a history of stroke at dialysis initiation. We used the National Health Insurance Research Database of Taiwan to evaluate whether peritoneal dialysis (PD) or hemodialysis (HD) confers a survival advantage for patients with incident ESRD and prior stroke.

Methods

We identified 975 patients undergoing PD and 975 propensity score-matched patients with newly diagnosed ESRD and prior stroke undergoing HD between 2000 and 2010. Both cohorts were followed up until the end of 2011. Comparisons of the risks of mortality between PD and HD were analyzed using the Cox proportional hazards regression model.

Results

In the propensity score-matched cohorts, there was a 2.4 per 100 person-years greater mortality in patients with PD (20.4 vs. 18.0 per 100 person-years) with an adjusted hazard ratio (HR) of 1.20 (95 % CI 1.06–1.36). For patients with diabetes, ESRD and prior stroke, patients undergoing PD had inferior survival compared with those undergoing HD (adjusted HR 1.22, 95 % CI 1.05–1.43), particularly among female patients (adjusted HR 1.55, 95 % CI 1.25–1.91). For patients with ESRD and prior stroke but without diabetes, there was no significant difference in mortality between PD and HD (adjusted HR 1.20, 95 % CI 0.96–1.50).

Conclusions

PD was associated with overall poorer survival among patients with diabetes, ESRD and prior stroke and with similar overall survival among patients with ESRD and prior stroke, but without diabetes, compared with HD.

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Acknowledgments

This study was conducted with support in part from the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002), the Research Laboratory of Pediatrics, Children’s Hospital of China Medical University (DMR-103-029), China Medical University Hospital (DMR-104-015), Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092), NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039-006), National Sciences Council of Taiwan (NSC 100-2621-M-039-001), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

Author information

Authors and Affiliations

  1. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan

    I-Kuan Wang & Fung-Chang Sung

  2. Department of Internal Medicine, College of Medicine, China Medical University, Taichung, 404, Taiwan

    I-Kuan Wang

  3. Division of Nephrology, China Medical University Hospital, Taichung, 404, Taiwan

    I-Kuan Wang, Yao-Lung Liu, Chiz-Tzung Chang & Chiu-Ching Huang

  4. Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, 404, Taiwan

    Wen-Miin Liang

  5. Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan

    Cheng-Li Lin & Fung-Chang Sung

  6. Department of Health Services Administration, China Medical University College of Public Health, 91 Hsueh Shih Road, Taichung, 404, Taiwan

    Cheng-Li Lin & Fung-Chang Sung

  7. Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan

    Tzung-Hai Yen

  8. Chang Gung University College of Medicine, Taoyuan, Taiwan

    Tzung-Hai Yen

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  1. I-Kuan Wang
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  8. Fung-Chang Sung
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Correspondence to Fung-Chang Sung.

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Wang, IK., Liang, WM., Lin, CL. et al. Impact of dialysis modality on the survival of patients with end-stage renal disease and prior stroke. Int Urol Nephrol 48, 139–147 (2016). https://doi.org/10.1007/s11255-015-1157-z

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  • DOI: https://doi.org/10.1007/s11255-015-1157-z

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