chronic kidney disease itself is a causal risk factor for stroke beyond traditional cardiovascular risk factors a nationwide cohort study in taiwan慢性肾脏疾病本身就是一个因果中风的风险因素除了传统心血管危险因素在台湾一个全国性的队列研究.pdfVIP

Chronic Kidney Disease Itself Is a Causal Risk Factor for Stroke beyond Traditional Cardiovascular Risk Factors: A Nationwide Cohort Study in Taiwan Yi-Chun Chen1,5, Yu-Chieh Su2,5, Ching-Chih Lee3,5*, Yung-Sung Huang4,5*, Shang-Jyh Hwang6 1 Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, 2 Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, 3 Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, 4 Division of Neurology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, 5 School of Medicine, Tzu Chi University, Hualien, Taiwan, 6 Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Abstract Background: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in patients with chronic kidney disease (CKD). In Taiwan, CVD is dominated by strokes but there is no robust evidence for a causal relationship between CKD and stroke. This study aimed to explore such causal association. Methods: We conducted a nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database from 2004 to 2007. Each patient identified was individually tracked for a full three years from the index admission to identify those in whom any type of stroke developed. The study cohort consisted of patients hospitalized with a principal diagnosis of CKD and no traditional cardiovascular risk factors at baseline (n = 1393) and an age-matched control cohort of patients hospitalized for appendectomies (n = 1393, a surrogate for the general population). Cox proportional hazard regression and propensity score model were used to compare the three-year stroke-free survival rate of the two cohorts a