The Risk of Stroke in Kidney Transplant Recipients with End-Stage Kidney Disease

Shih-Ting Huang, Tung-Min Yu, Ya-Wen Chuang, Mu-Chi Chung, Chen-Yu Wang, Pin-Kuei Fu, Tai-Yuan Ke, Chi-Yuan Li, Cheng-Li Lin, Ming-Ju Wu and Chia-Hung Kao
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Shih-Ting Huang: Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan
Tung-Min Yu: Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan
Ya-Wen Chuang: Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan
Mu-Chi Chung: Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan
Chen-Yu Wang: Department of Critical Care, Taichung Veterans General Hospital, Taichung 407, Taiwan
Pin-Kuei Fu: Department of Critical Care, Taichung Veterans General Hospital, Taichung 407, Taiwan
Tai-Yuan Ke: Division of Nephrology, Ministry of Health and Welfare Chiayi Hospital, Chiayi 600, Taiwan
Chi-Yuan Li: Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan
Cheng-Li Lin: Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
Ming-Ju Wu: Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan
Chia-Hung Kao: Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan

IJERPH, 2019, vol. 16, issue 3, 1-13

Abstract: Background : The incidence of stroke after kidney transplantation is poorly understood. Our study aimed to determine the incidence and predictors of stroke as well as mortality from stroke in kidney transplant recipients (KTRs). Methods : This retrospective cohort study used the National Health Insurance Research Database in Taiwan to study KTRs ( N = 4635), patients with end-stage renal disease (ESRD; N = 69,297), and patients from the general population who were chronic kidney disease (CKD)-free and matched by comorbidities ( N = 69,297) for the years 2000 through 2010. The risk of stroke was analyzed using univariate and multivariate Cox regression models and compared between study cohorts. Findings : Compared with the ESRD subgroup, KTRs had a significantly lower risk of overall stroke (adjusted hazard ratio (aHR) = 0.37, 95% confidence interval (CI) = 0.31–0.44), ischemic stroke (aHR = 0.45, 95% CI = 0.37–0.55), and hemorrhagic stroke (aHR = 0.20, 95% CI = 0.14–0.29). The risk patterns for each type of stroke in the KTR group were not significantly different than those of the CKD-free control subgroup. The predictors of stroke were age and diabetes in KTRs. All forms of stroke after transplantation independently predicted an increased risk of subsequent mortality, and the strongest risk was related to hemorrhagic events. Interpretation : KTRs had a lower risk of stroke than ESRD patients, but this risk was not significantly different from that of the CKD-free comorbidities-matched general population group. Although stroke was relatively uncommon among cardiovascular events, it predicted unfavorable outcome in KTRs.

Keywords: kidney transplant recipients; stroke; end-stage renal disease; chronic kidney disease (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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