Haemodialysis and the Risk of Stroke: A Population-based Cohort Study in Taiwan, a Country of High Incidence of End-stage Renal Disease

Aims: Data regarding the occurrence of stroke in dialysis patients are limited and epidemiologic studies to date are controversial with respect to the stroke subtype among dialysis patients. The aim of this study was to perform a population-based study with a retrospective cohort design to investigate the risk of stroke after the initiation of haemodialysis (HD) among end-stage renal disease (ESRD) patients in Taiwan - a country with the highest incidence of ESRD in the world.

Methods: Data were retrospectively obtained from the Taiwan National Health Insurance Research Database. In total, 644 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3220 patients matched for age and sex were included as the comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 5 year stroke-free survival rate between these two cohorts.

Results: The incidence rate of stroke (41.76 per 1000 person-years) was significantly higher in the HD cohort than in the control cohort (24.29 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios of ischaemic stroke and haemorrhagic stroke were 2.16 (95% confidence interval = 1.57-2.97) and 3.78 (95% confidence interval = 1.90-7.55), respectively.

Conclusion: We conclude that HD patients were at an increased risk for both ischaemic and haemorrhagic stroke compared with the general population.