Prognostic factors for acute ischemic stroke in patients undergoing hemodialysis

Abstract

Background Acute ischemic stroke (AIS) is a critical complication in patients undergoing dialysis. Although the improvement of AIS management is an urgent requirement, few studies have evaluated the prognostic factors of AIS in these patients. This study aimed to assess the relationship between clinical factors in patients undergoing dialysis and the prognosis of AIS. Methods Among 1267 patients who were hospitalized for AIS in Sendai City Hospital from January 2015 to June 2020, 81 patients undergoing hemodialysis were retrospectively enrolled. Multivariate analysis was performed to evaluate the effect of baseline characteristics, dialysis factors, and neurological severity of patients at admission [National Institutes of Health Stroke Scale (NIHSS) score] on in-hospital mortality, physical disability, and the need for rehabilitation transfer. Results A higher NIHSS score was a critical risk factor for each outcome and the only significant factor for in-hospital mortality [odds ratio (OR)/point 1.156, 95% confidence interval (CI) 1.054–1.267]. The risk factors of physical disability were NIHSS score (OR/point 1.458, 95% CI 1.064–1.998), older age (OR/year 1.141, 95% CI 1.022–1.274), diabetic nephropathy (OR 7.096, 95% CI 1.066–47.218), and higher premorbid modified Rankin scale (mRS) score (OR/grade 2.144, 95% CI 1.155–3.978); while those of rehabilitation transfer were a higher NIHSS score (OR/point 1.253, 95% CI 1.080–1.455), dialysis vintage (OR/year 1.175, 95% CI 1.024–1.349), and intradialytic hypotension before onset (OR 5.430, 95% CI 1.320–22.338). Conclusions Along with neurological severity, dialysis vintage, intradialytic hypotension, and diabetic nephropathy could worsen the prognosis of patients with AIS undergoing hemodialysis.

Stroke Iskemik pada Pasien Hemodialisis : Laporan Kasus

“…10 Cerebrovascular disease is a major cause of death in dialysis patients due to progressive atherosclerosis and chronic uremia. 14 Atrial fibrillation (AF) is a frequent comorbidity in hemodialysis patients, with a prevalence of up to 27%, significantly increasing the risk of ischemic stroke. 15 Toyoda et al reported ischemic stroke involving the vertebrobasilar artery region in hemodialysis patients.…”

The Predictive Value of Atherogenic Index of Plasma, Non- High Density Lipoprotein Cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and Lipoprotein Combine Index for Stroke Incidence and Prognosis in Maintenance Hemodialysis Patients

“… 6 , 7 Early identification of patients at high risk for AIS enables proactive prevention and intervention by physicians, which has important clinical implications. 8 …”

Mean Platelet Volume/Platelet Count Ratio as a Predictor of Both Incidence and Prognosis of Acute Ischemic Stroke in Hemodialysis Patients

“… 14 Identifying patients at high risk of AIS as early as possible can help physicians actively prevent and intervene, which has important clinical implications. 15 …”

“…14 Identifying patients at high risk of AIS as early as possible can help physicians actively prevent and intervene, which has important clinical implications. 15 Hyperactive platelets play a key role in thrombosis, leading to acute thrombotic events including AIS. 16,17 Circulating platelets vary in their volume and activity.…”