Clinical Features and Management of Intracranial Hemorrhage in Patients Undergoing Maintenance Dialysis Therapy

Murakami, Mamoru; Hamasaki, Tomoyuki; Kimura, Satoshi; Maruyama, Daisuke; Kakita, Kiyohito

doi:10.2176/nmc.44.225

Cited by 27 publications

(22 citation statements)

References 19 publications

(23 reference statements)

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“…[11,12] Little is known about the exact mechanism. It is assumed, however, that the decreased effect of a serine protease inhibitor on the hematoma, as seen in the current study, is associated with the suppressing effect on vasoconstriction occurring as the secondary phenomenon in the acute phase following the onset of cerebral bleeding.…”

Section: Discussionmentioning

confidence: 99%

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

et al. 2009

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Aims. The incidence of complications associated with cerebrovascular diseases in patients who receive hemodialysis for a long-term period is higher than that of other complications. It is known that mortality due to cerebral hemorrhage is two times higher compared to non-dialysis patients. Anti-coagulants used for hemodialysis are essential. Accordingly, in cases in which the cerebral hemorrhage occurred, the selection of anti-coagulants for the prevention of further bleeding poses a great challenge to physicians. The change of hematoma and patient prognosis has a direct relationship. Many ongoing studies are conducted to examine the causative factors causing the increased hematoma and their related prognostic factors. In the current study, we examined the effect of nafamostat mesylate (a serine protease inhibitor) on the change of hematoma compared to heparin in hemodialysis patients. Methods. The current study was conducted in 17 hemodialysis patients who developed a cerebral hemorrhage. These patients were assigned to two groups based on the type of anti-coagulants that they used (i.e., nafamostat mesylate and heparin). Then, the factors affecting the change of hematoma following the onset of cerebral hemorrhage were examined. The prognosis of hematoma was assessed based on brain CT scans, which were performed two weeks after the onset of cerebral hemorrhage in four groups. Following this, groups 1 (the decreased hematoma) and 2 (the decreased delay) were merged to group A (resolving group), and groups 3 (the increased hematoma) and 4 (the death following the aggravation) were merged to group B (the expansion group) for further analysis. Results. There were no significant differences in baseline characteristics between the nafamostat group and the heparin group. A comparison between the resolving group and the expansion group also showed that there were no significant differences in baseline characteristics. In the anti-coagulants and the change of hematoma, however, there were significant differences between the two groups (p = 0.024). A comparison of the change of hematoma between the four groups was also made. This showed that platelet counts and BUN level were significant factors (Platelet; p = 0.042, BUN; p = 0.043 ANOVA with resolving group). Conclusions. Nafamostat mesylate has a similar profile of anti-coagulative activity to heparin. It is assumed, however, that nafamostat has an affirmative effect on the recovery of damaged sites following the onset of cerebral hemorrhage. It is an anti-coagulant that can be safely used for hemodialysis following the onset of cerebral hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

et al. 2009

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“…In this study, we showed that the mortality rates were not significantly different for the EHD and CPD patients. In addition, our patients had a relatively lower mortality rate (total mortality 27.9%) than other series (mean mortality 62.1%, range 43.8–67.3%) [7,8,10,11,16,17,18]. The mean outcome score was 3 in the CPD and 2 in the EHD groups, respectively.…”

Section: Discussionmentioning

confidence: 48%

“…The prognosis of ICH in chronic dialysis patients is especially poor. The 30-day mortality rate has been reported to be as high as 67.3% (range 43.8–67.3%) [7,8,10,11,16,17,18]. The total 30-day mortality rate of our patients was 27.9%.…”

Section: Discussionmentioning

confidence: 55%

Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

Hsieh

Chen

et al. 2010

Am J Nephrol

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Background/Aims: The optimal mode of dialysis for end-stage renal disease (ESRD) patients with spontaneous intracerebral hemorrhage (ICH) remains controversial. We compared the outcomes of ESRD patients who received continuous peritoneal dialysis (CPD) or extended hemodialysis (EHD) after ICH, and investigated the factors determining prognosis.Methods: We incorporated our ICH patients with ESRD, requiring dialysis from January 2005 to December 2009. Patients were allocated to the CPD or EHD group according to the dialysis mode after ICH. We compared the 30-day mortality rate and modified Rankin Scale (mRS) of the two groups and analyzed the factors associated with mortality. Results: There were 40 patients with 16 episodes in CPD and 27 episodes in EHD group, without significant differences in baseline demographic data. The 30-day mortality rate and mRS were not different between the two groups. The patients who died within 30 days had higher ICH scores (4 ± 1 vs. 1 ± 1, p < 0.001) and outcome scores (5 ± 2 vs. 1 ± 1, p < 0.001). Dialysis-related complications occurred more frequently in the PD group (p = 0.07), but were unrelated to mortality. Conclusion: Among ESRD patients with ICH, EHD had a similar 30-day mortality rate and 30-day mRS to those receiving CPD. The mortality was significantly related to the severity of ICH.

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“…10,22) The prognosis for HD patients with large cerebral hematoma is poor. 18) The systolic and diastolic blood pressures before and after HD were significantly higher in the intracerebral hemorrhage group than in the control group. 13) History of hypertension and elevated diastolic pressure after the initial stroke are associated with increased risk of second stroke.…”

Section: Discussionmentioning

confidence: 80%

“…11,22,23) Management of intracerebral hemorrhage in HD patients is complicated by factors such as: hypotension during dialysis; active bleeding and coagulopathy that may be exacerbated by the systemic anticoagulant therapy used in HD; and dialysis disequilibrium syndrome. 18) The mortality of HD patients with intracerebral hemorrhage is nearly two times higher than that in non-HD patients. 22) Therefore, investigation of the predictors of intracerebral hemorrhage is important.…”

Section: Introductionmentioning

confidence: 99%

High Incidence of Microbleeds in Hemodialysis Patients Detected by T2*-Weighted Gradient-Echo Magnetic Resonance Imaging

Yokoyama¹,

Hirano

Uomizu³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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The incidence and characteristics of microbleeds in hemodialysis (HD) patients were investigated to elucidate the clinical significance with T 2 *-weighted gradient-echo magnetic resonance (MR) imaging. The 57 patients with chronic renal failure maintained by HD had no previous history of stroke. The control group consisted of 53 patients without previous history of stroke or chronic renal failure. The incidence and the number of microbleeds were assessed in the HD and control groups. The findings of microbleeds with T 2 *-weighted gradient-echo MR imaging were compared with those of T 1 -and T 2 -weighted MR imaging in HD patients. The incidence of microbleeds was significantly greater in the HD patients compared with the control patients. T 2 * -weighted gradient-echo imaging revealed a total of 44 microbleeds in 11 HD patients. T 2 -weighted imaging demonstrated 13 of 44 microbleeds as hyperintensity, whereas T 1 -weighted imaging demonstrated 12 lesions as hypointensity. T 2 -and T 1 -weighted imagings did not demonstrate any findings in 31 and 32 lesions, respectively. T 2 * -weighted gradientecho MR imaging is effective to detect microbleeds which may be a predictor of intracerebral hemorrhage in HD patients and should be included in the protocol for the study of cerebrovascular disease, because T 2 -and T 1 -weighted MR imaging recognizes microbleeds as lacunar infarction.

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Clinical Features and Management of Intracranial Hemorrhage in Patients Undergoing Maintenance Dialysis Therapy

Cited by 27 publications

References 19 publications

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

High Incidence of Microbleeds in Hemodialysis Patients Detected by T2*-Weighted Gradient-Echo Magnetic Resonance Imaging

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