Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis: The Q-cohort study

Ryusuke Yotsueda, Shigeru Tanaka, Masatomo Taniguchi, Kiichiro Fujisaki, Kumiko Torisu, Kosuke Masutani, Hideki Hirakata, Takanari Kitazono, Kazuhiko Tsuruya

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)856-864
Number of pages9
JournalNephrology Dialysis Transplantation
Volume33
Issue number5
DOIs
Publication statusPublished - May 1 2018

Fingerprint

Renal Dialysis
Hemoglobins
Cohort Studies
Stroke
Incidence
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis : The Q-cohort study. / Yotsueda, Ryusuke; Tanaka, Shigeru; Taniguchi, Masatomo; Fujisaki, Kiichiro; Torisu, Kumiko; Masutani, Kosuke; Hirakata, Hideki; Kitazono, Takanari; Tsuruya, Kazuhiko.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 5, 01.05.2018, p. 856-864.

Research output: Contribution to journalArticle

Yotsueda, Ryusuke ; Tanaka, Shigeru ; Taniguchi, Masatomo ; Fujisaki, Kiichiro ; Torisu, Kumiko ; Masutani, Kosuke ; Hirakata, Hideki ; Kitazono, Takanari ; Tsuruya, Kazuhiko. / Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis : The Q-cohort study. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 5. pp. 856-864.
@article{adad742825384325925371bb305456de,
title = "Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis: The Q-cohort study",
abstract = "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.",
author = "Ryusuke Yotsueda and Shigeru Tanaka and Masatomo Taniguchi and Kiichiro Fujisaki and Kumiko Torisu and Kosuke Masutani and Hideki Hirakata and Takanari Kitazono and Kazuhiko Tsuruya",
year = "2018",
month = "5",
day = "1",
doi = "10.1093/ndt/gfx305",
language = "English",
volume = "33",
pages = "856--864",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "5",

}

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

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

AN - SCOPUS:85047328077

VL - 33

SP - 856

EP - 864

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 5

ER -