Inflammatory markers and risk of cerebrovascularevents in patients initiating dialysis

Background and objectives Stroke remains a leading cause of morbidity and mortality for patients on dialysis;however, its risk factors in this population and measures to prevent it are not well understood.Design, setting, participants, & measurements We investigated whether inflammation was associated withcerebrovascular events in a national US cohort of 1041 incident dialysis patients enrolled from October 1995to June 1998 and followed until January 31, 2004. Incident cerebrovascular events were defined as nonfatal(hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. WithCox proportional hazards regression analysis accounting for the competing risk of nonstroke death, we assessedthe independent event risk associated with baseline levels of multiple inflammatory markers (highsensitivityC-reactive protein [hsCRP], interleukin-6 (IL-6), matrix metalloproteinase-3 [MMP-3], and P-selectin)and hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) use, which mayhave pleiotropic inflammatory effects.Results 165 patients experienced a cerebrovascular event during 3548 person-years of follow-up; overall incidencerate was 4.9/100 person-years. None of the inflammatory markers were associated with cerebrovascularevent risk (adjusted hazard ratios [HRs] per log unit [95% confidence interval]: hsCRP, 0.97 [0.85 to1.11]; IL-6, 1.04 [0.85 to 1.26]; MMP-3, 1.02 [0.70 to 1.48]; P-selectin, 0.98 [0.57 to 1.68]). Statin use was alsonot associated with significant risk of events in unadjusted (HR 1.07 [0.69 to 1.68]) or propensity-score adjustedanalyses (HR 0.98 [0.61 to 1.56]).Conclusions In conclusion, neither inflammatory markers nor statin use was associated with risk of cerebrovascularevents. Further studies are needed to understand the pathophysiology and prevention of stroke inpatients on dialysis.