Trend in the Incident Risk of Ischemic Stroke Among Patients on Kidney Replacement Therapy in Alberta, Canada

Background: Kidney failure increases cardiovascular disease risk. Kidney replacement therapy (KRT) further exacerbates this risk contributing to greater morbidity and mortality. We evaluated trends in ischemic stroke and associated risk factors among KRT patients Methods: A retrospective cohort study of adults initiating KRT in Alberta (Jan 2010–Mar 2019), categorized by baseline KRT modality: hemodialysis (HD), peritoneal dialysis (PD), or kidney transplant (KT). The primary outcome was annual rates of acute ischemic stroke, including recurrent events. Secular trends were analyzed using a zero-inflated negative binomial model with a log link, accounting for repeated measures via a cluster sandwich estimator. Fully adjusted models included age, sex, and key clinical variables. We compared the three KRT groups to individuals without CKD and those with non-dialysis CKD using standardized mean differences Results: We included 7,304 participants: 4,603 started on HD (median age 64.0, 68.1% male), 1,333 on PD (median age 59.3, 63.0% male), and 1,368 received KT (median age 52.2, 65.8% male). Median follow-up was 3.8 [2.1-6.5] years. Common comorbidities included hypertension (89-91%), diabetes (39-62%), coronary artery disease (35-44%), and heart failure (21-43%). Adjusted ischemic stroke incidence rates increased from 1.69 to 2.14 per 100 person-years for HD, 1.13 to 2.42 for PD, and 0.21 to 2.74 for KT from 2009-21 (Figure 1). Stroke incidence significantly increased for KT (incident risk ratio [IRR] 1.26, 95% CI 1.10–1.45, P=0.001). Increases for HD and PD were small and non-significant (HD: IRR 1.02, 95% CI 0.97–1.08, P=0.416; PD: IRR 1.07, 95% CI 0.99–1.15, P=0.068) Conclusion: Ischemic stroke incidence is rising among KRT patients, particularly post KT. Further study into novel risk factors and prevention in this population is warrantedFigure 1: Adjusted incidence rate of acute ischemic stroke in HD, PD, and KT.