Association of intermittent versus continuous hemodialysis modalities with mortality in the setting of acute stroke among patients with end-stage renal disease.

Autor:	Morgan MC; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA., Waller JL; Department of Population Health Science, Medical College of Georgia at Augusta University, Augusta, Georgia, USA., Bollag WB; Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA wbollag@augusta.edu.; Research, Charlie Norwood VA Medical Center, Augusta, Georgia, USA., Baer SL; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.; Infection Control and Epidemiology, Charlie Norwood VA Medical Center, Augusta, Georgia, USA., Tran S; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA., Kheda MF; Southwest Georgia Nephrology, Albany, Georgia, USA., Young L; Department of Physiological and Technological Nursing, Augusta University, Augusta, Georgia, USA., Padala S; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA., Siddiqui B; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA., Mohammed A; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	Journal of investigative medicine : the official publication of the American Federation for Clinical Research [J Investig Med] 2022 Oct; Vol. 70 (7), pp. 1513-1519. Date of Electronic Publication: 2022 Jun 09.
DOI:	10.1136/jim-2022-002439
Abstrakt:	Patients with end-stage renal disease (ESRD) are 8-10 times more likely to suffer from a stroke compared with the general public. Despite this risk, there are minimal data elucidating which hemodialysis modality is best for patients with ESRD following a stroke, and guidelines for their management are lacking. We retrospectively queried the US Renal Data System administrative database for all-cause mortality in ESRD stroke patients who received either intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). Acute ischemic stroke and hemorrhagic stroke were identified using the International Classification of Diseases 9th Revision (ICD-9)/ICD-10 codes, and hemodialysis modality was determined using Healthcare Common Procedure Coding System (HCPCS) codes. Time to death from the first stroke diagnosis was the outcome of interest. Cox proportional hazards modeling was used, and associations were expressed as adjusted HRs. From the inclusion cohort of 87,910 patients, 92.9% of patients received IHD while 7.1% of patients received CRRT. After controlling for age, race, sex, ethnicity, and common stroke risk factors such as hypertension, diabetes, tobacco use, atrial fibrillation, and hyperlipidemia, those who were placed on CRRT within 7 days of a stroke had an increased risk of death compared with those placed on IHD (HR=1.28, 95% CI 1.25 to 1.32). It is possible that ESRD stroke patients who received CRRT are more critically ill. However, even when the cohort was limited to only those patients in the intensive care unit and additional risk factors for mortality were controlled for, CRRT was still associated with an increased risk of death (HR=1.32, 95% CI 1.27 to 1.37). Therefore, further prospective clinical trials are warranted to address these findings. Competing Interests: Competing interests: SLB is an Editorial Board member for the Journal of Investigative Medicine. (© American Federation for Medical Research 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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