Comparative Outcomes and Risk Analysis of Stroke Incidence in Adult Patients on Dialysis

Background: Kidney failure requiring dialysis and its associated costs create substantial burdens on healthcare systems. This study leverages electronic healthcare data to analyze comorbid stroke incidence in ICU dialysis patients over time, characterize stroke epidemiology, and compare outcomes between ICU dialysis stroke patients and non-stroke ICU dialysis patients. Methods: Using ICD-10 and CPT code queries, adult (18-90 years) ICU patients on dialysis from March 2004 to March 2024 were categorized into three cohorts: (1) non-stroke patients (n=120,414), (2) stroke patients (n=5,750), and (3) ICU dialysis patients (n=128,564). These cohorts were filtered by exclusion factors (kidney transplant status and history of stroke). Cohorts 1 and 2 were propensity-matched for severity of illness (use of vasopressors or ventilation), demographics, diagnoses, medications, and lab values (n=5,698) and used for the comparative outcomes analysis. Cohort 2 pre-matching was also used for the risks analysis, and cohort 3 was used for the incidence and prevalence analysis. Results: The identified comorbidities for stroke were diabetes (18.42% of patients), heart failure (17.01%), hypertension (13.62%), atrial fibrillation (12.07%), coronary artery disease (11.27%), peripheral artery disease (3.27%), sleep apnea (1.16%), arthritis (0.29%), and lupus (0.08%). ICU dialysis stroke patients had significant increases (p<0.05) in rates of mortality (+4.30%) and ventilation/intubation (+1.98%), while non-stroke patients had significant increases (p<0.05) in ED visitation (+7.95%) and rehospitalization (+4.42%). ICU readmission rates showed no significant difference (p=0.07). Women and older adults reported higher stroke risk, but there were no significant disparities across racial and ethnic groups. Conclusion: Stroke has a significant, adverse impact on ICU dialysis patients. Preventative strategies targeting stroke comorbidities are crucial to enhancing patient well-being and mitigating stroke burden.