背景
過去研究顯示，洗腎患者有較高的腦中風危險。然而，關於不同透析模式是否與腦中風的發生風險有關的研究並不多。我們利用全國性資料，針對不同透析模式對出血性腦中風與缺血性腦中風發生的危險，進行回顧性世代研究，並與一般大眾的腦中風發生危險做比較。

方法
使用1998年1月到2009年12月的全民健保資料庫進行研究，共有75,285位新發生之血液透析患者與4,185位新發生之腹膜透析患者，符合年齡大於18歲、過去不曾發生腦中風、沒有癌症、不曾改變透析模式或接受過腎臟移植之研究選樣條件。將選出之洗腎患者與非洗腎之參考族群，利用Cox多變量比例風險模式控制可能之干擾因子，比較因出血性腦中風住院及缺血性腦中風住院的發生危險。此外，進行統計分析時，加入傾向分數來減少可能之選樣誤差。

結果
血液透析與腹膜透析患者相對於參考族群，有較高的缺血性腦中風住院發生率 (分別為136.25、90及19.81/ 10000人年)和出血性腦中風住院發生率 (分別為78.97、52.23及7.09/10000人年)。在多變量分析中，除了血液透析與腹膜透析所帶來的影響之外，年齡是影響腦中風危險最重要的因子。男性性別、糖尿病、及高血壓會增加缺性腦中風發生的危險。就出血性腦中風而言，男性性別與高血壓會增加其發生危險。針對透析族群以血液透析患者作比較基準顯示，腹膜透析患者在控制可能變因後，出血性中風危險(危險比, 0.75; 95%信賴區間, 0.58-0.96) 低於血液透析患者。在缺血性腦中風的危險(危險比, 0.89; 95%信賴區間, 0.74-1.07)則與血液透析患者無顯著差異。
結論
相較於參考族群，洗腎患者有較高的腦中風危險，特別是出血性腦中風。腹膜透析患者發生出血性腦中風的危險低於血液透析患者，但在缺血性腦中風部分則無顯著差異。針對洗腎患者，除透析治療以外，良好的血壓、血糖、與血脂肪控制仍是預防腦中風發生的重要課題。

Background
Patients undergoing maintenance dialysis have excess risk for stroke. We performed a nation-wide retrospective cohort study to determine the risks of ischemic stroke and hemorrhagic stroke among incident hemodialysis (HD) and peritoneal dialysis (PD) patients in comparison with a reference cohort randomly sampled from the general population in Taiwan.
Methods
From the data of National Health Insurance Research Database (NHIRD) between 1998 and 2009, we identified 75,782 HD patients, 4,152 PD patients, and 669,773 non-dialysis subjects who were older than 18 years of age, had no history of stroke and cancer, and no change of treatment modality to determine their incidence rates of hospitalized ischemic and hemorrhagic strokes. After stratification by propensity score to receive HD, we constructed multivariable proportional-hazard regression model to estimate hazard ratios with adjustment for possible confounders.
Results
Both HD and PD patients had higher incidence of hospitalized ischemic stroke (136.25 and 90 /10000 person-years) and hemorrhagic stroke (78.97 and 52.23 /10000 person-years) in comparison with the reference cohort (19.81 and 7.09 /10000 person-years). In addition to PD and HD, older age, male gender, diabetes, and hypertension were independent risk factors for ischemic stroke. In hemorrhagic stroke, however, only patients with a male gender or hypertension had a significant excess risk. Using HD as the comparison group, we found PD patients had lower risks for hemorrhagic stroke (HR, 0.75; 95% CI, 0.58-0.96) but no significant risk difference for ischemic stroke (HR, 0.89; 95% CI, 0.74-1.07) after adjusting for all the potential confounders.
Conclusion
Patients undergoing dialysis have elevated risks for stroke, especially hemorrhagic subtype. Patients undergoing PD appear less likely to develop hemorrhagic stroke than HD patients and have similar risk for ischemic stroke as HD patients. A comprehensive control of hypertension, hyperglycemia, and hyperlipidemia is necessary to accompany with dialysis treatment.

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