Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis

Kawamura, Mitsunobu; Fijimoto, Shouichi; Hisanaga, Shuichi; Yamamoto, Yoshitaka; Eto, Tanenao

doi:10.1053/ajkd.1998.v31.pm9631844

Cited by 169 publications

(144 citation statements)

References 22 publications

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“…In their study, patients on dialysis had significantly higher odds of experiencing AIS than non‐dialysis patients (odd ratio 6.1, and 10.1 for white males and females and 4.3 and 6.5 for black males and females, P <0.001 for all). Other studies investigating the incidence of AIS in dialysis patients were single center, non‐contemporary or primarily involved non‐US population 2, 8, 16, 17, 18. To our knowledge, this is the largest study examining contemporary rates of AIS in the dialysis and non‐dialysis population.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke

Alqahtani

Berzingi

Aljohani

et al. 2018

JAHA

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BackgroundThere is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (AIS) in patients on maintenance dialysis.Methods and ResultsWe used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of AIS in dialysis patients. A total of 930 010 patients were admitted with AIS between 2003 and 2014, of whom 13 642 (1.5%) were on dialysis. Overall, the incidence of AIS among dialysis patients decreased significantly (P trend<0.001), while it remained stable in non‐dialysis patients (P trend=0.78). Compared with non‐dialysis patients, those on dialysis were younger (67±13 years versus 71±15 years, P<0.001), and had higher prevalence of major comorbidities. Black patients constituted 35.2% of dialysis patients admitted with AIS compared with 16.7% of patients in the non‐dialysis group (P<0.001). After propensity score matching, in‐hospital mortality was higher in the dialysis group (7.6% versus 5.2%, P<0.001), but this mortality gap narrowed overtime (P trend<0.001). Hemorrhagic conversion and gastrointestinal bleeding rates were similar, but blood transfusion was more common in the dialysis group. Rates of severe disability surrogates (tracheostomy, gastrostomy, mechanical ventilation and non‐home discharge) were also similar in both groups. However, dialysis patients had longer hospitalizations, and accrued a 25% higher total cost of acute care.ConclusionsDialysis patients have 8‐folds higher incidence of AIS compared withnon‐dialysis patients. They also have higher risk‐adjusted in‐hospital mortality, sepsis and blood transfusion, longer hospitalizations, and higher cost. There is a need to identify preventative strategies to reduce the risk of AIS in the dialysis population.

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Section: Discussionmentioning

confidence: 99%

Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke

Alqahtani

Berzingi

Aljohani

et al. 2018

JAHA

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“…Any association with anticoagulant administration was not clear, because 85% of patients with intracerebral hemorrhage developed symptoms later than 6 hours after the end of dialysis, and there were no significant differences in hematoma size between these patients and those who developed symptoms within 6 hours after the end of dialysis. 9) The incidence of intracerebral hemorrhage in patients undergoing chronic hemodialysis is 24.4% within 1 year and 57.7% within 5 years of dialysis initiation, and the mortality rate within 30 days of the onset of intracerebral hemorrhage is 56.2%. Higher blood pressure, especially diastolic pressure higher than 90 mmHg, is associated with a higher incidence of cerebrovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, cerebrovascular disease accounts for 12.7% of deaths in patients receiving chronic hemodialysis in Japan, compared to only 4.8% in the United States, where the rate of renal transplantation is relatively high. 6,9) The incidence of intracerebral hemorrhage is especially high, compared to cerebral infarction or subarachnoid hemorrhage, at 0.6-1.0% per year, which corresponds to a 5-10 times higher risk than for the general population. [5][6][7]9) In addition, the mortality rate of patients with chronic hemodialysis who suffer intracerebral hemorrhage is two times higher than that in non-hemodialysis patients, and may be as high as 78.9% within 30 days of symptom onset.…”

Section: Introductionmentioning

confidence: 99%

“…6,9) The incidence of intracerebral hemorrhage is especially high, compared to cerebral infarction or subarachnoid hemorrhage, at 0.6-1.0% per year, which corresponds to a 5-10 times higher risk than for the general population. [5][6][7]9) In addition, the mortality rate of patients with chronic hemodialysis who suffer intracerebral hemorrhage is two times higher than that in non-hemodialysis patients, and may be as high as 78.9% within 30 days of symptom onset. 8) Hematomas in patients undergoing hemodialysis are larger and more likely to increase in size after symptom onset, due to the associated tendency for bleeding, leading to the higher mortality rate, and the outcome is especially poor in patients with hematoma enlargement after hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Miyahara¹,

Murata²,

Abé³

2007

Neurol. Med. Chir.(Tokyo)

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The factors associated with hematoma enlargement were analyzed in 24 patients, 16 males and eight females aged 46 to 77 years (mean 58 years), undergoing chronic hemodialysis who were admitted to our hospital with intracerebral hemorrhage between 1994 and 2003. Computed tomography demonstrated hematoma enlargement in eight patients after admission. Age, sex, duration of dialysis, time interval between onset and admission, site of hemorrhage, and blood pressure on admission were not significantly different between patients with and without hematoma enlargement. However, level of consciousness, size and shape of hematoma, prothrombin time, and fibrin degradation product level were significantly different between the two patient groups (p º 0.05). All patients with hematoma enlargement died during the course of treatment. Intracerebral hemorrhage is more difficult to treat in hemodialysis patients than in non-hemodialysis patients, and the outcome is especially poor in patients with large hematoma. The present study suggests that lower level of consciousness, large and irregular hematoma, prolonged prothrombin time, and high fibrin degradation product level are predictors of hematoma enlargement after admission.

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“…[158][159][160][161][162][163][164] As previously discussed, controversy relates to the specific relationship between the BP measurement times and technique (predialytic, postdialytic, or intradialytic BP measurements or interdialytic ambulatory BP) and morbidity and mortality. Some studies suggest an association of high BP with strokes, 165,166 cerebral atrophy, 167 cardiovascular events, 168 complex cardiac arrhythmias, 169 the development of congestive heart failure, 161 and all-cause mortality. 170 Other studies suggest that low BP measured either predialysis or postdialysis is associated with increased mortality.…”

Section: Relationship Of Bp and Mortalitymentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

159

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis

Cited by 169 publications

References 22 publications

Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke

Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke

Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Assessment and Management of Hypertension in Patients on Dialysis

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