TY - JOUR
T1 - Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis
T2 - The Q-cohort study
AU - Yotsueda, Ryusuke
AU - Tanaka, Shigeru
AU - Taniguchi, Masatomo
AU - Fujisaki, Kiichiro
AU - Torisu, Kumiko
AU - Masutani, Kosuke
AU - Hirakata, Hideki
AU - Kitazono, Takanari
AU - Tsuruya, Kazuhiko
N1 - Funding Information:
This study was supported by the Kidney Foundation (H19 JKFB 07-13, H20 JKFB 08-8, H23 JKFB 11-11) and the Japan Dialysis Outcome Research Foundation (H19-076-02, H20-003).
Publisher Copyright:
© The Author 2017.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background. The contribution of the hemoglobin concentration to the incidence of hemorrhagic or ischemic stroke in patients undergoing hemodialysis is unclear. Methods. In total, 3436 patients undergoing prevalent hemodialysis were followed up for 4 years. The primary outcome was the first development of hemorrhagic or ischemic stroke. The baseline hemoglobin concentration was divided into quartiles [hemoglobin (g/dL): Q1,9.7; Q2, 9.8-10.5; Q3, 10.6-11.1; Q4,11.2]. The association between the hemoglobin concentration and each type of stroke was examined using the Kaplan- Meiermethod and a Cox proportional hazardsmodel. Results. During the follow-up period, 76 (2.2%) patients developed hemorrhagic stroke and 139 (4.0%) developed ischemic stroke. The 4-year incidence rate of hemorrhagic stroke was significantly higher in patients with lower hemoglobin concentrations. Compared with the quartile of patients with the highest hemoglobin concentrations (Q4), the multivariable-adjusted hazard ratios for hemorrhagic stroke were 1.18 (95% confidence interval, 0.56-2.51), 1.59 (0.82-3.21) and 2.31 (1.16-4.73) in patients in Q3, Q2 and Q1, respectively. No association was identified between the 4-year incidence rate of ischemic stroke and the hemoglobin concentration. Compared with the quartile of patients with the lowest hemoglobin concentrations (Q1), the multivariable-adjusted hazard ratios for ischemic stroke were 1.17 (95% confidence interval, 0.73-1.89), 0.88 (0.51-1.51) and 1.10 (0.66-1.83) in patients in Q2, Q3 and Q4, respectively. Conclusions. Our results suggest that low hemoglobin concentrations are associated with a high risk of hemorrhagic stroke, but not of ischemic stroke, in patients undergoing hemodialysis.
AB - Background. The contribution of the hemoglobin concentration to the incidence of hemorrhagic or ischemic stroke in patients undergoing hemodialysis is unclear. Methods. In total, 3436 patients undergoing prevalent hemodialysis were followed up for 4 years. The primary outcome was the first development of hemorrhagic or ischemic stroke. The baseline hemoglobin concentration was divided into quartiles [hemoglobin (g/dL): Q1,9.7; Q2, 9.8-10.5; Q3, 10.6-11.1; Q4,11.2]. The association between the hemoglobin concentration and each type of stroke was examined using the Kaplan- Meiermethod and a Cox proportional hazardsmodel. Results. During the follow-up period, 76 (2.2%) patients developed hemorrhagic stroke and 139 (4.0%) developed ischemic stroke. The 4-year incidence rate of hemorrhagic stroke was significantly higher in patients with lower hemoglobin concentrations. Compared with the quartile of patients with the highest hemoglobin concentrations (Q4), the multivariable-adjusted hazard ratios for hemorrhagic stroke were 1.18 (95% confidence interval, 0.56-2.51), 1.59 (0.82-3.21) and 2.31 (1.16-4.73) in patients in Q3, Q2 and Q1, respectively. No association was identified between the 4-year incidence rate of ischemic stroke and the hemoglobin concentration. Compared with the quartile of patients with the lowest hemoglobin concentrations (Q1), the multivariable-adjusted hazard ratios for ischemic stroke were 1.17 (95% confidence interval, 0.73-1.89), 0.88 (0.51-1.51) and 1.10 (0.66-1.83) in patients in Q2, Q3 and Q4, respectively. Conclusions. Our results suggest that low hemoglobin concentrations are associated with a high risk of hemorrhagic stroke, but not of ischemic stroke, in patients undergoing hemodialysis.
UR - http://www.scopus.com/inward/record.url?scp=85047328077&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047328077&partnerID=8YFLogxK
U2 - 10.1093/ndt/gfx305
DO - 10.1093/ndt/gfx305
M3 - Article
C2 - 29237088
AN - SCOPUS:85047328077
SN - 0931-0509
VL - 33
SP - 856
EP - 864
JO - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress
JF - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress
IS - 5
ER -