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Tolu Ehindero

Supervisor(s): Aminu Bello
Award:  KRESCENT Summer Studentship
Institution:  University of Alberta
Year: 2024

Project Title: Risk and trend in the burden of stroke among patients on chronic maintenance dialysis

Background: Patients with kidney failure undergoing chronic maintenance dialysis have a higher risk of cardiovascular diseases compared to the general population. The heightened risk of cardiovascular disease in these populations is attributed to a combination of traditional risk factors, such as hypertension, hyperlipidemia, and diabetes, and non-traditional risk factors specific to chronic kidney disease (CKD), including altered hemodynamics, inflammation, and vascular calcification. This study seeks to provide critical insights into the burden of acute ischemic stroke and associated risk factors in dialysis.
Purpose: To evaluate the trend in the burden of stroke, and determine key risk factors among patients undergoing chronic dialysis treatment in Alberta.
Method: This study is designed as a retrospective cohort of people receiving maintenance dialysis using the administrative data of the Alberta Kidney Disease Network (AKDN) from 2010-2019. The first incidence of acute ischemic stroke or a new incidence in individuals with a history of acute ischemic strokes will be documented. Demographic and clinical factors will be compared between individuals undergoing maintenance dialysis with occurrence of acute ischemic stroke and those without a stroke incidence. Risk factors for stroke will be explored. We will also compare differences in stroke incidence and risk factors by dialysis modality i.e. hemodialysis versus peritoneal dialysis.
Outcomes: The primary outcome is the incidence of first episode of acute ischemic stroke.
The secondary outcomes are all-cause mortality, CV-related mortality and strokes, recurrent stroke events.
Patient Engagement:  We will involve patients with lived experience of dialysis and stroke to provide further guidance on the study proposal, analysis plan and how to generate a data that is most relevant to improve patients experience and outcomes.
Relevance to patient/community: This study is important as it will determine the burden and determinant of stroke in a very high risk population group. This will enhance patient care through targeted prevention strategies, early detection methods, and personalized treatment plans, ultimately improving health outcomes and quality of life for patients on dialysis. Additionally, providing clear information about stroke risk empowers patients to make informed decisions regarding their health, including choosing between dialysis modalities and adopting lifestyle changes to mitigate risk of stroke. Furthermore, the study's findings can benefit caregivers and families by increasing awareness of the stroke risk and the importance of monitoring and managing contributing factors, thereby fostering a more supportive environment for those affected by CKD and dialysis.
Conclusion: The risk of strokes in maintenance dialysis population is not fully understood. This research will help determine the burden and determinants of strokes in this high risk population group. The data generated can help inform patient, policymakers and health care providers on the burden, determinants (sociodemographic and clinical) of stroke, and identify gaps that may be amenable to interventions via enabling policies for prevention and risk mitigation.