Incidence, Etiology, and Outcome of Stroke in Patients on Continuous Ambulatory Peritoneal Dialysis

Abstract

Background: Little information exists on clinical features of stroke in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The goals of this study was to clarify features of stroke in CAPD patients, to determine factors to predict onset of stroke during chronic CAPD, and to determine whether CAPD had an advantage over hemodialysis (HD) for prevention of stroke. Methods: We determined features of stroke in 12 patients (14 attacks including 7 parenchymal and 1 subarachnoid hemorrhage and 6 infarction) among 188 consecutive patients on CAPD, and compared them with those of 137 stroke patients among 1,681 consecutive patients on hemodialysis. Results: Incidence of stroke for CAPD patients (15.7 per 1,000 person-years) was high compared with that of HD patients (approximately 12) or general residents in our suburban town. Patients with stroke on CAPD were younger than those on HD (52 ± 12 vs. 62 ± 11 years, p = 0.008). Mean arterial pressure (MAP) of patients with stroke increased after the introduction of CAPD (p = 0.01), whereas that of patients without stroke did not change. Increase in MAP during chronic CAPD was related independently to the occurrence of total stroke or brain hemorrhage. The majority of CAPD patients with stroke (67%) were dead or dependent in the chronic stage of stroke. Conclusion: CAPD patients seem to have a greater risk of stroke than the general population primarily because of poor control of hypertension, presumably in part due to overhydration. CAPD does not seem to have an advantage over HD for the prevention of stroke.