Cerebrovascular Disease Hospitalization Rates in End-Stage Kidney Disease Patients with Kidney Transplant and Peripheral Vascular Disease: Analysis Using the National Inpatient Sample (2005-2019)

Tyler John Canova; Rochell Issa; Patrick Baxter; Ian Thomas; Ehab Eltahawy; Obi Ekwenna

doi:10.3390/healthcare12040454

Cerebrovascular Disease Hospitalization Rates in End-Stage Kidney Disease Patients with Kidney Transplant and Peripheral Vascular Disease: Analysis Using the National Inpatient Sample (2005-2019)

Healthcare (Basel). 2024 Feb 10;12(4):454. doi: 10.3390/healthcare12040454.

Authors

Tyler John Canova¹, Rochell Issa², Patrick Baxter³, Ian Thomas⁴, Ehab Eltahawy⁵, Obi Ekwenna⁶

Affiliations

¹ College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614, USA.
² Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
³ Schar School of Policy and Government, George Mason University, Fairfax, VA 22030, USA.
⁴ Department of Nephrology & Transplant, Mount St. John's Medical Center, St. John's, Antigua and Barbuda.
⁵ Department of Cardiovascular Medicine, The University of Toledo Medical Center, Toledo, OH 43614, USA.
⁶ Department of Urology & Transplant, The University of Toledo Medical Center, Toledo, OH 43614, USA.

Abstract

Individuals with end-stage kidney disease (ESKD) face higher cerebrovascular risk. Yet, the impact of peripheral vascular disease (PVD) and kidney transplantation (KTx) on hospitalization rates for cerebral infarction and hemorrhage remains underexplored. Analyzing 2,713,194 ESKD hospitalizations (2005-2019) using the National Inpatient Sample, we investigated hospitalization rates for ischemic and hemorrhagic cerebrovascular diseases concerning ESKD, PVD, KTx, or their combinations. Patients hospitalized with cerebral infarction due to thrombosis/embolism/occlusion (CITO) or artery occlusion resulting in cerebral ischemia (AOSI) had higher rates of comorbid ESKD and PVD (4.17% and 7.29%, respectively) versus non-CITO or AOSI hospitalizations (2.34%, p < 0.001; 2.29%, p < 0.001). Conversely, patients hospitalized with nontraumatic intracranial hemorrhage (NIH) had significantly lower rates of ESKD and PVD (1.64%) compared to non-NIH hospitalizations (2.34%, p < 0.001). Furthermore, hospitalizations for CITO or AOSI exhibited higher rates of KTx and PVD (0.17%, 0.09%, respectively) compared to non-CITO or AOSI hospitalizations (0.05%, p = 0.033; 0.05%, p = 0.002). Patients hospitalized with NIH showed similar rates of KTx and PVD (0.04%) versus non-NIH hospitalizations (0.05%, p = 0.34). This nationwide analysis reveals that PVD in ESKD patients is associated with increased hospitalization rates with cerebral ischemic events and reduced NIH events. Among KTx recipients, PVD correlated with increased hospitalizations for ischemic events, without affecting NIH. This highlights management concerns for patients with KTx and PVD.

Keywords: cerebrovascular hemorrhage; cerebrovascular ischemia; end-stage kidney disease; kidney transplant; peripheral vascular disease.

Grants and funding

This project was partially supported by the Presidential Student Mentorship Grant awarded to Rochell Issa in June 2022 by the American Society of Transplant Surgeons. The content is solely the responsibility of the authors and does not necessarily represent the official views of the ASTS.