Correlation between a Bedridden Status and the Long-term Outcome in Hemodialysis Patients after Intracerebral Hemorrhaging

Yamashita, Ayuko; Kitamura, Mineaki; Tateishi, Yohei; Torigoe, Kenta; Muta, Kumiko; Mochizuki, Yoshinari; Izumo, Tsuyoshi; Matsuo, Takayuki; Tsujino, Akira; Sakai, Hideki; Mukae, Hiroshi; Nishino, Tomoya

doi:10.2169/internalmedicine.8006-21

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…In this cohort, patients with ischemic heart diseases tended to be on dual antiplatelet therapy (DAPT). Although DAPT is mandatory for several months in patients with implanted drug-eluting stents, long-term antiplatelet therapy increases the risk of hemorrhagic complications, particularly in patients on HD 38 , 39 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Kitamura

Yamaguchi

Ota

et al. 2021

Sci Rep

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Although polypharmacy is common among patients on hemodialysis (HD), its association with prognosis remains unclear. This study aimed to elucidate the association between the number of prescribed medicines and all-cause mortality in patients on HD, accounting for essential medicines (i.e., antihypertensives, antidiabetic medicines, and statins) and non-essential medicines. We evaluated 339 patients who underwent maintenance HD at Nagasaki Renal Center between July 2011 and June 2012 and followed up until June 2021. After adjusting for patient characteristics, the number of regularly prescribed medicines (10.0 ± 4.0) was not correlated with prognosis (hazard ratio [HR]: 1.01, 95% confidence interval [CI] 0.97–1.05, p = 0.60). However, the number of non-essential medicines (7.9 ± 3.6) was correlated with prognosis (HR: 1.06, 95% CI 1.01–1.10, p = 0.009). Adjusting for patient characteristics, patients who were prescribed more than 10 non-essential medicines were found to have a significantly higher probability of mortality than those prescribed less than five non-essential medicines, with a relative risk of 2.01 (p = 0.004). In conclusion, polypharmacy of non-essential medicines increases the risk of all-cause mortality in patients on HD. As such, prescribing essential medicines should be prioritized, and the clinical relevance of each medicine should be reviewed by physicians and pharmacists.

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Section: Discussionmentioning

confidence: 99%

Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Kitamura

Yamaguchi

Ota

et al. 2021

Sci Rep

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“…Among diseases and health complications in older adults, stroke and dementia can evoke high rates of dysphagia [2], which is known to be associated with malnutrition [3]. These complications and mental problems (i.e., dementia) of older patients undergoing hemodialysis [4][5][6][7] can also have a negative impact on activities of daily living, feeding status, and nutritional status, thus, resulting in poor prognosis [8,9]. However, the dysphagia status has not been commonly evaluated at dialysis facilities compared to nursing homes.…”

Section: Introductionmentioning

confidence: 99%

Importance of feeding status evaluation in older patients undergoing hemodialysis

et al. 2023

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Older hospitalized patients undergoing hemodialysis are increasingly experiencing malnutrition caused by dysphagia. However, only a few studies have focused on this problem. We used the Kuchikara Taberu Balance Chart (KTBC) to evaluate the patients’ feeding status and examined its association with their nutritional status and prognosis. This study included elderly patients undergoing hemodialysis who were hospitalized at Nagasaki Renal Center for > 3 days between June 2021 and February 2022. In total, 82 inpatients were included [mean age, 73.4 ± 10.0 years; men, 57.3%; median dialysis vintage, 79.0 months (interquartile range, 37.3–164.8)]. We classified patients with lower than the median KTBC score (57 points) as being at risk for dysphagia; 37 patients (45.1%) were at risk for dysphagia. Spearman’s rank correlation coefficient (ρ) elucidated that the KTBC total score was significantly associated with each nutritional indicator [serum albumin level (ρ = 0.505, p < 0.001); geriatric nutritional risk index (ρ = 0.600, p < 0.001); and nutritional risk index (ρ = -0.566, p < 0.001)]. The KTBC score was also closely associated with the body mass index (ρ = 0.228, p = 0.04). Patients with a lower KTBC score showed poor prognosis (log-rank test: p = 0.001), and age- and sex-adjusted Cox proportional analysis showed that the KTBC score was associated with life prognosis (hazard ratio, 0.90; 95% confidential interval, 0.86–0.94; p < 0.001). Therefore, we concluded that the patients at risk of dysphagia, identified using the KTBC score, were malnourished and had a poor prognosis. Hence, the evaluation of dysphagia using the KTBC is encouraged to prevent malnutrition in vulnerable older patients undergoing hemodialysis.

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Functional prognosis following spontaneous intracerebral hemorrhage in patients on hemodialysis: a retrospective study of 100 consecutive cases

Watanabe,

Suzuki,

Inoue

et al. 2024

Ren Replace Ther

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Background Recently, discussions have increasingly focused on “withdrawal from dialysis” among patients undergoing dialysis who experience severe brain dysfunction as post-stroke sequelae. In this context, the lack of understanding regarding functional prognosis after spontaneous intracerebral hemorrhage in patients undergoing hemodialysis becomes a particularly important issue. Therefore, we aimed to evaluate the functional prognosis of intracerebral hemorrhage in patients undergoing hemodialysis when life-saving was prioritized and dialysis was not withdrawn. Furthermore, we sought to identify factors influencing life and functional prognosis. Methods We retrospectively analyzed data of 100 consecutive hemodialysis patients who experienced spontaneous intracerebral hemorrhage between 2012 and 2021. The in-hospital mortality rates and modified Rankin Scale (mRS) and Functional Independence Measure (FIM) scores at discharge and 90 days after onset were examined. Results The mean age of the patients was 65.7 years, with 29% of them undergoing life-saving brain surgery. The mRS score at discharge was 0, 1, 2, 3, 4, 5, and 6 (indicating death) in 0, 1, 13, 9, 26, 20, and 31 cases, respectively. Among the 69 surviving patients, the median FIM score at discharge was 37 (19–81), with 14 patients having an FIM score of 18 (i.e., complete dependence). Patients who underwent life-saving brain surgery showed a higher median mRS score [5, interquartile range (IQR) 5–6] and a lower FIM score (18, IQR 18–22) at discharge compared with those who did not undergo the surgery. Patients discharged with mRS and FIM scores of 5 and 18, respectively, had the same functional status at 90 days. The Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) score and intraventricular extension at admission were predictive of a mRS score ≥ 5 (area under the receiver operating characteristic curve = 0.92, p < 0.0001) and FIM score at discharge (adjusted R2 = 0.3, p = 0.0003). Conclusion In our single-center study, more than 14% of patients on hemodialysis with cerebral hemorrhage incurred severe, irreversible neurological and functional impairments, necessitating discussions on hemodialysis withdrawal. Moreover, FUNC score and intraventricular extension at admission were highly accurate predictors of functional prognosis.

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Correlation between a Bedridden Status and the Long-term Outcome in Hemodialysis Patients after Intracerebral Hemorrhaging

Cited by 4 publications

References 29 publications

Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Importance of feeding status evaluation in older patients undergoing hemodialysis

Functional prognosis following spontaneous intracerebral hemorrhage in patients on hemodialysis: a retrospective study of 100 consecutive cases

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