Trend in the Incident Risk of Ischemic Stroke Among Patients on Kidney Replacement Therapy in Alberta, Canada
Bibliographic record
Abstract
Background: Kidney failure increases cardiovascular disease risk. Kidney replacement therapy (KRT) further exacerbates this risk contributing to greater morbidity and mortality. We evaluated trends in ischemic stroke and associated risk factors among KRT patients Methods: A retrospective cohort study of adults initiating KRT in Alberta (Jan 2010–Mar 2019), categorized by baseline KRT modality: hemodialysis (HD), peritoneal dialysis (PD), or kidney transplant (KT). The primary outcome was annual rates of acute ischemic stroke, including recurrent events. Secular trends were analyzed using a zero-inflated negative binomial model with a log link, accounting for repeated measures via a cluster sandwich estimator. Fully adjusted models included age, sex, and key clinical variables. We compared the three KRT groups to individuals without CKD and those with non-dialysis CKD using standardized mean differences Results: We included 7,304 participants: 4,603 started on HD (median age 64.0, 68.1% male), 1,333 on PD (median age 59.3, 63.0% male), and 1,368 received KT (median age 52.2, 65.8% male). Median follow-up was 3.8 [2.1-6.5] years. Common comorbidities included hypertension (89-91%), diabetes (39-62%), coronary artery disease (35-44%), and heart failure (21-43%). Adjusted ischemic stroke incidence rates increased from 1.69 to 2.14 per 100 person-years for HD, 1.13 to 2.42 for PD, and 0.21 to 2.74 for KT from 2009-21 (Figure 1). Stroke incidence significantly increased for KT (incident risk ratio [IRR] 1.26, 95% CI 1.10–1.45, P=0.001). Increases for HD and PD were small and non-significant (HD: IRR 1.02, 95% CI 0.97–1.08, P=0.416; PD: IRR 1.07, 95% CI 0.99–1.15, P=0.068) Conclusion: Ischemic stroke incidence is rising among KRT patients, particularly post KT. Further study into novel risk factors and prevention in this population is warrantedFigure 1: Adjusted incidence rate of acute ischemic stroke in HD, PD, and KT.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".