ABSOLUTE RISK AND RISK FACTORS FOR STROKE MORTALITY IN PATIENTS WITH END STAGE KIDNEY DISEASE (ESKD): RETROSPECTIVE POPULATION-BASED COHORT USING DATA LINKAGE

NL DE LA MATA1, M ALFARO-RAMIREZ2, P MASSON3, RA SALMAN4, P KELLY1, AC WEBSTER1,5,6

1Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, NSW, Australia; 3Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK; 4Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK; 5Centre for Renal and Transplant Research, Westmead Hospital, Westmead, NSW, Australia;  6Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia.

Aim: To determine the absolute risk of stroke mortality, and associated risk factors, in the Australian and New Zealand ESKD population.

Background: People with ESKD have a higher risk of stroke than the general population.

Methods: Analysis included incident ESKD patients in Australia 1980-2013 and New Zealand 1988-2012, from ANZDATA. We ascertained primary cause of death from data linkage with national death registries and risk factors from ANZDATA. We used a competing risks regression model to identify risk factors and cumulative incidence of stroke and non-stroke mortality.

Results: A total of 58,241 ESKD patients were included in the analysis. There were 873 stroke deaths and 33,445 non-stroke deaths over 259,973 person-years (pys). Overall, the cumulative incidence of stroke death was 6.2% (95% CI: 5.5-6.9%) and non-stroke death was 22.5% (95% CI: 22.1-22.8%) at 2-year follow-up. A higher risk of stroke death was associated with older age (Subhazard ratio, SHR 1.70, 95% CI: 1.26-2.28, p<0.001), female sex (SHR 1.37, 95% CI: 1.16-1.61, p<0.001), prior stroke cerebrovascular disease (SHR 2.25, 95% CI: 1.87-2.72, p<0.001), diabetic CKD (SHR 1.27, 95% CI: 1.00-1.59, p=0.013), year of ESKD ≤1995 (SHR 1.52, 95% CI: 1.20-1.89, p value<0.001), normal BMI (SHR 1.72, 95% CI: 1.37-2.13, p<0.001), and no previous malignancy (SHR 1.61, 95% CI: 1.32-1.96, p<0.001).

Conclusions: The risk of stroke death in ESKD patients was higher with older age, cerebrovascular disease and diabetes. In the context of ESKD females and those with normal BMI, there was a greater risk of stroke mortality but not of non-stroke mortality.  Further research is warranted to determine whether targeted stroke interventions could benefit ESKD patients

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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