Comparative analysis of ischemic and hemorrhagic stroke hospitalization rates in end-stage kidney disease and kidney transplant patients with and without atrial fibrillation

Introduction: Atrial fibrillation (AF) in end-stage kidney disease (ESKD) and kidney transplant (KTx) recipients presents challenges in stroke risk management. This study aimed to compare hospitalization rates for ischemic and hemorrhagic cerebrovascular events in ESKD and KTx patients with and without AF.

Methods: Using the National Inpatient Sample (2005-2019), retrospective analysis was conducted on hospitalizations for ESKD and KTx patients with and without AF. Baseline characteristics and hospitalization rates for five cerebral ischemic conditions and one hemorrhagic condition were compared. Descriptive statistics and t-tests were employed for analysis.

Results: Among ESKD patients, those with AF exhibited significantly higher hospitalization rates for ischemic stroke, including 1)Cerebral infarction due to thrombosis, embolism, occlusion (0.11% vs. 0.08%,p<0.001), 2)Cerebral infarction due to thrombosis, embolism, and unspecified occlusion (1.93% vs. 1.51%, p<0.001), 3)Artery occlusion resulting in cerebral ischemia (1.37% vs. 0.93%,p<0.001), 4)Cerebral artery occlusion resulting in cerebral ischemia (0.48% vs. 0.42%,p<0.001), while experiencing lower rates of intraoperative and postprocedural cerebrovascular infarction (0.88% vs. 0.97%,p<0.001) compared to those without AF. Conversely, KTx patients with AF showed increased hospitalizations for hemorrhagic stroke, particularly nontraumatic intracranial hemorrhage (0.79% vs. 0.56%,p<0.001), compared to those without AF. However, they did not exhibit significant differences in hospitalization rates for most ischemic conditions, except for cerebral infarction due to thrombosis, embolism, and unspecific occlusion (1.62% vs. 1.11%,p<0.001) and artery occlusion resulting in cerebral ischemia (0.84% vs. 0.52%,p<0.001).

Conclusion: Our findings reveal patterns in hospitalization rates between ESKD and KTx patients with AF compared to those without AF, with ESKD patients with AF exhibiting higher rates of ischemic stroke compared to ESKD patients without AF and KTx patients with AF showing increased hospitalizations for hemorrhagic stroke compared to those without AF. These findings demonstrate the impact of AF on hospitalization rates for ischemic and hemorrhagic cerebrovascular events in both ESKD and KTx patients.