Association between stroke risk and metformin use in hemodialysis patients with diabetes mellitus: A nested case-control study

Li Nien Chien, Chu Lin Chou, His Hsien Chen, Chih Chin Kao, Yen Chung Lin, Yueh Lin Wu, Jin Shuen Chen, Li Ying Chen, Te Chao Fang

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6 Citations (Scopus)

Abstract

Background--Metformin use reduces the incidence and severity of stroke in patients with type 2 diabetes mellitus (DM). The benefits of metformin for stroke have not been examined in hemodialysis patients with DM. Methods and Results--Using the National Health Insurance Research Database, we identified 17 760 patients with DM and newonset hemodialysis between 2001 and 2013. Of these, 1898 patients hospitalized for either ischemic or hemorrhagic stroke were matched to 7592 control patients according to sex, age, and year of initial hemodialysis therapy by using incidence sampling. The association between metformin use and stroke risk was estimated using conditional logistic regression after adjustment for hemodialysis frequency, comorbidity, and prescribed medications. Metformin use was recorded before the date of stroke admission and the date of pseudostroke of the case and control patients, respectively. Results showed that hemodialysis patients with ischemic stroke were more likely to use metformin than the controls 1 year before the date of stroke admission (adjusted odds ratio: 1.64; 95% confidence interval, 1.32-2.04). The association was evident within 90 days before the index date (adjusted odds ratio: 1.81; 95% confidence interval, 1.27-2.60). The results were consistent with those of hemodialysis patients with hemorrhagic stroke. Metformin use remained a risk factor for stroke in patients treated with antihypertensive, sulfonylurea, and antiplatelet drugs. Conclusions--This nested case-control study is the first to show that metformin use is associated with stroke risk in hemodialysis patients with DM. We suggest that metformin should not be used by hemodialysis patients with DM.

Original languageEnglish
Article numbere007611
JournalJournal of the American Heart Association
Volume6
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

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Metformin
Renal Dialysis
Case-Control Studies
Diabetes Mellitus
Stroke
Odds Ratio
Confidence Intervals
Platelet Aggregation Inhibitors
Incidence
National Health Programs
Type 2 Diabetes Mellitus
Antihypertensive Agents
Comorbidity
Logistic Models
Databases

Keywords

  • Diabetes mellitus
  • Diabetes mellitus (kidney)
  • Diabetic therapy/glitazones
  • Hemodialysis
  • Metformin
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Association between stroke risk and metformin use in hemodialysis patients with diabetes mellitus: A nested case-control study",
abstract = "Background--Metformin use reduces the incidence and severity of stroke in patients with type 2 diabetes mellitus (DM). The benefits of metformin for stroke have not been examined in hemodialysis patients with DM. Methods and Results--Using the National Health Insurance Research Database, we identified 17 760 patients with DM and newonset hemodialysis between 2001 and 2013. Of these, 1898 patients hospitalized for either ischemic or hemorrhagic stroke were matched to 7592 control patients according to sex, age, and year of initial hemodialysis therapy by using incidence sampling. The association between metformin use and stroke risk was estimated using conditional logistic regression after adjustment for hemodialysis frequency, comorbidity, and prescribed medications. Metformin use was recorded before the date of stroke admission and the date of pseudostroke of the case and control patients, respectively. Results showed that hemodialysis patients with ischemic stroke were more likely to use metformin than the controls 1 year before the date of stroke admission (adjusted odds ratio: 1.64; 95{\%} confidence interval, 1.32-2.04). The association was evident within 90 days before the index date (adjusted odds ratio: 1.81; 95{\%} confidence interval, 1.27-2.60). The results were consistent with those of hemodialysis patients with hemorrhagic stroke. Metformin use remained a risk factor for stroke in patients treated with antihypertensive, sulfonylurea, and antiplatelet drugs. Conclusions--This nested case-control study is the first to show that metformin use is associated with stroke risk in hemodialysis patients with DM. We suggest that metformin should not be used by hemodialysis patients with DM.",
keywords = "Diabetes mellitus, Diabetes mellitus (kidney), Diabetic therapy/glitazones, Hemodialysis, Metformin, Stroke",
author = "Chien, {Li Nien} and Chou, {Chu Lin} and Chen, {His Hsien} and Kao, {Chih Chin} and Lin, {Yen Chung} and Wu, {Yueh Lin} and Chen, {Jin Shuen} and Chen, {Li Ying} and Fang, {Te Chao}",
year = "2017",
month = "11",
day = "1",
doi = "10.1161/JAHA.117.007611",
language = "English",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
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number = "11",

}

TY - JOUR

T1 - Association between stroke risk and metformin use in hemodialysis patients with diabetes mellitus

T2 - A nested case-control study

AU - Chien, Li Nien

AU - Chou, Chu Lin

AU - Chen, His Hsien

AU - Kao, Chih Chin

AU - Lin, Yen Chung

AU - Wu, Yueh Lin

AU - Chen, Jin Shuen

AU - Chen, Li Ying

AU - Fang, Te Chao

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background--Metformin use reduces the incidence and severity of stroke in patients with type 2 diabetes mellitus (DM). The benefits of metformin for stroke have not been examined in hemodialysis patients with DM. Methods and Results--Using the National Health Insurance Research Database, we identified 17 760 patients with DM and newonset hemodialysis between 2001 and 2013. Of these, 1898 patients hospitalized for either ischemic or hemorrhagic stroke were matched to 7592 control patients according to sex, age, and year of initial hemodialysis therapy by using incidence sampling. The association between metformin use and stroke risk was estimated using conditional logistic regression after adjustment for hemodialysis frequency, comorbidity, and prescribed medications. Metformin use was recorded before the date of stroke admission and the date of pseudostroke of the case and control patients, respectively. Results showed that hemodialysis patients with ischemic stroke were more likely to use metformin than the controls 1 year before the date of stroke admission (adjusted odds ratio: 1.64; 95% confidence interval, 1.32-2.04). The association was evident within 90 days before the index date (adjusted odds ratio: 1.81; 95% confidence interval, 1.27-2.60). The results were consistent with those of hemodialysis patients with hemorrhagic stroke. Metformin use remained a risk factor for stroke in patients treated with antihypertensive, sulfonylurea, and antiplatelet drugs. Conclusions--This nested case-control study is the first to show that metformin use is associated with stroke risk in hemodialysis patients with DM. We suggest that metformin should not be used by hemodialysis patients with DM.

AB - Background--Metformin use reduces the incidence and severity of stroke in patients with type 2 diabetes mellitus (DM). The benefits of metformin for stroke have not been examined in hemodialysis patients with DM. Methods and Results--Using the National Health Insurance Research Database, we identified 17 760 patients with DM and newonset hemodialysis between 2001 and 2013. Of these, 1898 patients hospitalized for either ischemic or hemorrhagic stroke were matched to 7592 control patients according to sex, age, and year of initial hemodialysis therapy by using incidence sampling. The association between metformin use and stroke risk was estimated using conditional logistic regression after adjustment for hemodialysis frequency, comorbidity, and prescribed medications. Metformin use was recorded before the date of stroke admission and the date of pseudostroke of the case and control patients, respectively. Results showed that hemodialysis patients with ischemic stroke were more likely to use metformin than the controls 1 year before the date of stroke admission (adjusted odds ratio: 1.64; 95% confidence interval, 1.32-2.04). The association was evident within 90 days before the index date (adjusted odds ratio: 1.81; 95% confidence interval, 1.27-2.60). The results were consistent with those of hemodialysis patients with hemorrhagic stroke. Metformin use remained a risk factor for stroke in patients treated with antihypertensive, sulfonylurea, and antiplatelet drugs. Conclusions--This nested case-control study is the first to show that metformin use is associated with stroke risk in hemodialysis patients with DM. We suggest that metformin should not be used by hemodialysis patients with DM.

KW - Diabetes mellitus

KW - Diabetes mellitus (kidney)

KW - Diabetic therapy/glitazones

KW - Hemodialysis

KW - Metformin

KW - Stroke

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DO - 10.1161/JAHA.117.007611

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VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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