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Increased Risk of Ischemic Stroke in Patients with Chronic Kidney Disease after Recurrent Dysnatremias: A Nationwide Population-Based Cohort Study

Author(s): Mu-Chi Chung, Tung-Min Yu, Ming-Ju Wu, Peir-Haur Hung, Chao-Hsiang Chang, Chih-Hsin Muo, Kuo-Hsiung Shu,Chi-Jung Chung


Dysnatremias are the common problems in chronic kidney disease (CKD) patients anda sso  c     iat ed with neurologic symptoms. Thus, the purpose of this study was to determinethe association between dysnatremias (either hypernatremia or hyponatremia) and risk ofstroke in CKD population. A retrospective cohort study was constructed using the claimsdata of the entire insured residents covered by Taiwan’s universal health insurance from2000 to 2011. Severe hypona tremia and hypernatremia are defined as the need of 3% sodiumchloride treatment and the need of admission respectively. A total of 365 hyponatremia and137 hypernatremia patients and 1983 matched comparisons were recruited. The incidenceof stroke was defined using the International Classification of Diseases, 9th Revision, ClinicalModification. Cox proportional hazard regression and Kaplan–Meier curves were usedfor the analyses. In the analysis, CKD with dysnatremias were with more diabetes, heart fai lure,  men tal illness, liver cirrhosis, cancer history and diuretics treatment. Compared withcomparisons, patients with dysnatremias, hyponatremia or hypernatremia patients had a 2.57(95% CI: 1.91-3.46), 2.35 (95% CI: 1.67-3.29) and 3.35 (95% CI: 2.04-5.50) fold risks of stroke afteradjusting for potential factors. There was similarly increased risk for ischemic stroke but not
for hemorrhagic stroke. In addition, patients with rec urrent dysnatremias, the risk of str  okemuch increased [9.19 (95% CI: 5.79-14.6) for hyponatremia and 11.4 (95% CI: 5.66-23.1) forhypernatremia]. In conclusion, we suggest more intensive surveillance to prevent recurrentdysnatremias and ischemic stroke should be emphasized.

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