Abstract 19761: Contemporary Nationwide Outcomes of Acute Ischemic Stroke in Patients on Maintenance Hemodialysis

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Introduction: the management of acute ischemic stroke (AIS) in hemodialysis patients is challenging.

Methods: we utilized the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns and outcomes of AIS in hemodialysis patients.

Results: 930,010 patients were admitted with AIS between 2003-2014, of whom 10186 (1.1%) were on dialysis. Dialysis patients were younger (67±13 vs. 71±15, p<0.001), had a higher percentage of black patients that the non-dialysis group (36.2% vs. 16.8%, p<0.001), and a higher prevalence of major comorbidities. The utilization of thrombolysis and mechanical thrombectomy increased overtime (Figure1). Adjusted in-hospital mortality was higher in the dialysis group (6.9% vs. 5.6%, p<0.001), however this mortality gap narrowed overtime (Figure1). Adjusted bleeding complications, surrogates of moderate-severe disability were similar to non-dialysis patients (Table1). However, dialysis patients had higher rates of sepsis and blood transfusion and had a 25% higher total cost of care.

Conclusion: About 1% of patient admitted with AIS are on maintenance dialysis, of whom 36.2% are black. Similar to non-dialysis patients, the management of AIS in dialysis patients has evolved in the last decade and led to a significant decrease in its associated morbidity and mortality. Further studies are needed to examine the high incidence of AIS in black patients on dialysis.

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