Outcomes of transient ischemic attack in maintenance dialysis patients and those with chronic kidney disease.

BACKGROUND: In-hospital outcomes of transient ischemic attack (TIA) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) requiring maintenance dialysis are largely unknown. We evaluated TIA-related in-hospital outcomes in these patients using a national database. METHODS: Our study is observational in nature. Data from all adult (≥ 18 years) patients admitted to US hospitals between 2005 and 2011 with a primary discharge diagnosis of TIA and secondary diagnosis of CKD and ESRD were included using the Nationwide In-Patient Sample. We aimed to compare the following TIA-related outcomes between CKD and ESRD patients: (i) degree of disability (mainly functional status) derived from discharge destination, (ii) length of stay, (iii) charges of hospitalization, and (iv) mortality. The comparisons of TIA-related mortality and discharge outcomes between CKD and ESRD were analyzed after adjusting for potential confounders using logistic regression analysis. We adjusted for age, sex, co-morbidities, hospital size and hospital teaching status. RESULTS: A total of 18 316 dialysis and 67 256 CKD patients were admitted with TIA in the study period (2005-11). On univariate analysis, there was no difference in the rates of moderate-to-severe disability (20.5% versus 20.2%, P = 0.7) and in-hospital mortality (0.4% versus 0.2%, P = 0.07) in ESRD patients compared with those with CKD. After adjusting for age, sex and potential confounders, ESRD patients with TIA had higher odds of moderate-to-severe disability at discharge [odds ratio (OR): 1.53, 95% confidence interval (CI): 1.37-1.71, P ≤ 0.0001] and in-hospital death (OR: 2.87, 95% CI: 1.29-6.37, P = 0.009). CONCLUSION: ESRD patients with TIA have significantly higher rates of moderate-to-severe disability at discharge and in-hospital mortality when compared with the patients of other stages of CKD who are not dialysis-dependent.

Acute renal failure worsens in-hospital outcomes in patients with intracerebral hemorrhage.

BACKGROUND: Occurrence of acute renal failure (ARF) is more common in patients with intracerebral hemorrhage (ICH) compared with those with other stroke subtypes. We sought to determine the frequency and effect of ARF on in-hospital outcomes of patients with ICH. METHODS: We analyzed data from all patients admitted to the United States' hospitals between 2005 and 2011 with the primary discharge diagnosis of ICH and secondary diagnosis of ARF. The associations of ARF with mortality and discharge outcomes in ICH patients were analyzed after adjusting for potential confounders using logistic regression analyses. RESULTS: Of the 614,454 patients admitted with ICH, 41,694 (6.8%) had ARF. In-hospital dialysis was required in 700 (1.7%) patients. ICH patients with ARF had higher rates of moderate-to-severe disability (49.5% versus 44.2%; P < .0001) and in-hospital mortality (28.7% versus 22.4%; P < .0001) compared with those without ARF. After adjusting for age, gender, and potential confounders defined as statistically significant variables on univariate analysis, ICH patients with ARF had higher odds of moderate-to-severe disability (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3; P < .0001) and death (OR, 1.5; 95% CI, 1.4-1.6; P < .0001). The rates of moderate-to-severe disability and death were 37.5% and 50.2% among those who required dialysis, respectively. CONCLUSIONS: In patients with ICH, ARF is associated with significantly higher rates of in-hospital mortality and moderate-to-severe disability at the time of discharge.

Outcomes of endovascular versus intravenous thrombolytic treatment for acute ischemic stroke in dialysis patients.

BACKGROUND AND OBJECTIVES: To compare the outcomes of IV thrombolytics (tissue plasminogen activator or tPA) with endovascular treatment (intra-arterial tPA ± mechanical thrombectomy) in dialysis patients who suffered from acute ischemic stroke. STUDY DESIGN: Observational study. SETTING AND PARTICIPANTS: Data analysis from Nationwide Inpatient Sample (NIS 2005- 2010) including dialysis patients presenting with acute ischemic stroke, either treated with IV thrombolytics or endovascular treatment. OUTCOMES: Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. We determined the effect of endovascular treatment on in-hospital mortality, disability at discharge, and post-thrombolytic intracerebral hemorrhages (ICH) after adjusting for potential confounders using multivariate analysis. RESULTS: Of the 2 313 dialysis patients with ischemic stroke, 1 398 (60%) received IV thrombolytics and 915 (40%) were treated with endovascular treatment. The in-hospital mortality rate and moderate-to-severe disability were lower in dialysis patients receiving endovascular treatment (7.6% vs. 14.5% p = 0.04) and (30% vs. 52% p = <.0001), respectively. After adjusting for age, gender, and potential confounders, endovascular treatment was associated with lower in-hospital mortality (OR 0.5, 95% CI 0.2-0.9) and moderate-to-severe disability (OR 0.3, 95% CI 0.2-0.5). CONCLUSIONS: The odds of both in-hospital mortality and moderate to severe disability were lower with endovascular treatment in dialysis patients. Such data support the preferential use of endovascular treatment in this patient population.