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