Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke.

BACKGROUND: There is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis.

METHODS AND RESULTS: We used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of AIS in dialysis patients. A total of 930 010 patients were admitted with AIS between 2003 and 2014, of whom 13 642 (1.5%) were on dialysis. Overall, the incidence of AIS among dialysis patients decreased significantly ( P trend <0.001), while it remained stable in non-dialysis patients ( P trend =0.78). Compared with non-dialysis patients, those on dialysis were younger (67±13 years versus 71±15 years, P <0.001), and had higher prevalence of major comorbidities. Black patients constituted 35.2% of dialysis patients admitted with AIS compared with 16.7% of patients in the non-dialysis group ( P <0.001). After propensity score matching, in-hospital mortality was higher in the dialysis group (7.6% versus 5.2%, P <0.001), but this mortality gap narrowed overtime ( P trend <0.001). Hemorrhagic conversion and gastrointestinal bleeding rates were similar, but blood transfusion was more common in the dialysis group. Rates of severe disability surrogates (tracheostomy, gastrostomy, mechanical ventilation and non-home discharge) were also similar in both groups. However, dialysis patients had longer hospitalizations, and accrued a 25% higher total cost of acute care.

CONCLUSIONS: Dialysis patients have 8-folds higher incidence of AIS compared withnon-dialysis patients. They also have higher risk-adjusted in-hospital mortality, sepsis and blood transfusion, longer hospitalizations, and higher cost. There is a need to identify preventative strategies to reduce the risk of AIS in the dialysis population.