Nationwide Trends in Stroke Among Patients Undergoing Hemodialysis by Sex and Race: An Analysis From the US Renal Database

BACKGROUND: The risk of ischemic stroke hospitalization in patients with end-stage kidney disease has declined over time, but data are limited, especially for hemorrhagic stroke trends. Race- and sex-based differences have not been well studied. METHODS AND RESULTS: We conducted a retrospective cohort study using the US Renal Data System to examine the incidence of stroke among incident patients undergoing hemodialysis from 2006 to 2016. We identified 391 195 new patients undergoing hemodialysis (mean age, 70.1 years; 44.8% women) between 2006 and 2016. The incidence of any stroke per 100 000 patients decreased from 2746 cases at 1 year and 6823 cases at 3 years during 2006 to 2009 to 1983 cases at 1 year and 5162 cases at 3 years in 2014 to 2016 (P<0.001). Women had higher stroke incidence than men (P<0.001). White adults had higher incidence compared with Black adults, Hispanic adults, and Other (Native American participants and those whose racial and ethnic identification did not align with the classifications) race (P<0.001). The risk decreased over the study period for both sexes and races, except "Other" race. Hemorrhagic stroke incidence was 409 cases at 1 year and 1125 at 3 years per 100 000. No sex difference was observed at 1 year, but women had higher 3-year rates (P=0.005). Black and Hispanic adults had higher 3-year hemorrhagic stroke rates than White adults (P<0.001). Decreases occurred only for women, Black adults, and Hispanic adults at 1 year. CONCLUSIONS: While the overall risk of stroke remains high after hemodialysis initiation, significant reductions in stroke risk have occurred over the past decade across sexes and racial groups.