Dear Sir,

We agree with Fustes and Rodriguez’s observation(1) that the length of stay in patients with stroke is related to several factors, including medical complications, severity of stroke, age and social factors.

With regard to the length of stay of the patients in our study, we wish to clarify that we had studied 563 patients, and the findings of only 37 patients with chronic kidney disease (CKD),(2) end-stage renal failure, and those on dialysis were analysed and published. The outcome data only consists of patients with CKD who were on dialysis. The data of the other stroke patients from the study group is currently under review for publication. The average length of stay of our patients with stroke who did not have CKD and were not undergoing dialysis was much shorter and varied between 7 and 20 (average 17.5) days. Patients with CKD and those on haemodialysis tend to have other comorbidities such as diabetes mellitus, hypertension and related complications such as ischaemic heart disease, impaired cardiac reserve and peripheral vascular disease, which may lead to lower limb amputations. These patients also have a propensity for arrhythmia and comorbidities owing to their chronic inflammatory state. Hence, stroke per se may not be the only factor responsible for the longer hospital stay and poor survival.

Our previous studies indicated that CKD is a significant factor affecting mortality in patients with lower limb amputation and hip fractures.(3,4) We also observed that patients who underwent unplanned emergency dialysis had worse survival outcomes.(5)

Fustes OJH, Rodriguez CA. Comment on:Influence of chronic kidney disease and haemodialysis on stroke outcome. Singapore Med J. 2021;62:615.
Pande SD, Morris J. Influence of chronic kidney disease and haemodialysis on stroke outcome. Singapore Med J. 2021;62:594-8.
Pande SD, Kamal A, Zaw E, Tin AS. Patients following lower limb amputation:a retrospective cohort study showing how to improve survival and rehabilitation outcomes. Int J Surg Open. 2019;20:24-8.
Roy D, Pande S, Thalanki S, et al. Hip fractures in elderly patients with non-dialysis dependent chronic kidney disease:outcomes in a Southeast Asian population. Medicine (Baltimore). 2021;100:e26625.
Roy D, Roy Chowdhury A, Pande S, Kam JW. Evaluation of unplanned dialysis as a predictor of mortality in elderly dialysis patients:a retrospective data analysis. BMC Nephrol. 2017;18:364.