Inequality in care and differences in outcome following stroke in people with end stage renal disease: results from a national registry linkage analysis

Introduction:\ud Stroke rate and mortality are greater in people with end-stage renal disease (ESRD) than those without. We examined discrepancies in stroke-care in ESRD patients and its influence on mortality.\ud \ud Methods:\ud A national record-linkage cohort study of hospitalised stroke from 2005-2013. Presentation, measures of care quality (admission to stroke unit, swallow assessment, anti-thrombotic or thrombolysis use) and outcomes were compared in those with and without ESRD after propensity score matching (PSM). We examined the effect being admitted to a stroke unit on survival using Kaplan-Meier and Cox survival analyses.\ud \ud Results:\ud 8,757 people with ESRD and 61,367 people with stroke were identified. 486 ESRD patients experienced stroke over 34,551.9 years follow-up; incidence rates 25.3 (dialysis) and 4.5 (kidney transplant)/ 1000 patient-years. Following PSM, dialysis patients were less likely to be functionally independent (61.4 vs 77.7%, p