Original InvestigationDialysisCerebrovascular Disease Incidence, Characteristics, and Outcomes in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study
Section snippets
Study Design
Study participants were from the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.9 This national prospective cohort study of incident dialysis patients was initiated in 1995 to investigate treatment choices and clinical outcomes in dialysis care. Eligibility criteria for enrollment in CHOICE included new onset of long-term dialysis therapy in the preceding 3 months, ability to provide informed consent, age 18 years or older, and ability to speak English or
Results
Approximately two-thirds of eligible patients were enrolled in CHOICE from participating dialysis units. Eligible patients enrolled were similar to eligible, but unenrolled, patients with regard to age, sex, dialysis modality, albumin level, and blood pressure. Baseline characteristics of the 1,041 CHOICE participants are listed in Table 1. Age, sex, race, and dialysis modality distributions were similar to those of the 1997 US dialysis population, as described previously.16 During a median
Discussion
In this national prospective cohort study of patients initiating dialysis therapy for end-stage renal disease, cerebrovascular events, including fatal and nonfatal clinical stroke and CEA, occurred 10 times more frequently than in the general population,8, 17 with an incidence rate of 4.9 events/100 person-years. The majority of events were related to ischemic stroke, with cardioembolic stroke the most common form of ischemic stroke in dialysis patients. To our knowledge, this is 1 of the first
Acknowledgements
We thank the patients, staff, laboratory, and medical directors of the participating clinics at DCI, New Haven CAPD, and St Raphael's Hospital who contributed to the study. We thank members of the Cardiovascular Endpoint Committee: Michael J. Choi, MD; Joseph A. Eustace, MD, MHS; Caroline Fox, MD, MPH; Melanie H. Katzman, MD, MHS; Michael J. Klag, MD, MPH; Yongmei Liu, MD, PhD; J. Craig Longenecker, MD, PhD; Michal Melamed, MD, MHS; Renuka Sothinathan, MD, MHS; Richard M. Ugarte, MD, MHS; and
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Originally published online as doi: 10.1053/j.ajkd.2009.01.261 on April 20, 2009.
Because the Editor-in-Chief recused himself from consideration of this manuscript, the Deputy Editor (Daniel E. Weiner, MD, MS) served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.