Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients

Abstract

Background and Purpose-In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients. Methods-Cranial MRI, including T2*-weighted magnetic resonance imaging, was performed on 179 hemodialysis patients with no past history of cerebrovascular events. The patients were followed prospectively until death or renal transplantation. We used the Cox proportional hazards model with inverse probability of treatment weighting using the propensity score to compare the event-free survivals of patients with/without CMBs. For sensitivity analyses, stratification by propensity score quintile and regression adjustment were used. Results-CMBs were detected in 45 of the 179 patients. During a median follow-up period of 5.0 years, stroke occurred in 24 patients, including 12 with intracerebral hemorrhage and 12 with cerebral infarctions. Cox proportional hazards analysis with inverse probability of treatment weighting using the propensity score revealed that the presence of CMBs was a strong and significant predictor of intracerebral hemorrhage (hazard ratio, 26.53; 95% confidence interval, 2.88-244.90) but not cerebral infarction (hazard ratio, 0.91; 95% confidence interval, 0.25-3.34). Sensitivity analyses yielded similar results. Conclusions-This study showed that the presence of CMBs was an independent and strong predictor of intracerebral hemorrhage in stroke-free hemodialysis patients, indicating that hemodialysis patients with CMBs should be carefully monitored for future onset of intracerebral hemorrhage.

Strategies for the Super-Aged Dialysis Population: Survival Benefits or Alternative Goals?

“…Hemodialysis patients were reported to have a high prevalence of cerebral microbleeds (CMBs) [35,36], and older age and high blood pressure (BP) were found to be powerful factors associated with the presence of CMBs [35]. Actually, the presence of CMBs is a powerful and significant predictor of intracerebral hemorrhage, with a hazard ratio of 26.5 (95% CI 2.8-244.9) [37]. Figure 6 shows declining RRs of mortalities in all age groups over a recent 20-year period.…”

Neurocritical Care for Patients with Kidney Dysfunction

“…Diminished eGFR appears to be an independent risk factor for cerebral microbleeds, raising the possibility that a uremic milieu may predispose to microbleed formation [115]. In a cohort of Japanese hemodialysis patients who were strokefree at baseline, presence of cerebral microbleeds was an independent predictor of intracerebral hemorrhage during a 5-year follow-up period [116].…”

Cerebrovascular disease in end-stage kidney disease

“…Cerebral microbleeds have been reported to affect the occurrence of cerebral hemorrhage [26][27][28][29]. Naganuma et al [29] performed cranial MRI, including T2*-weighted MRI, on 179 hemodialysis patients with no past history of cerebrovascular events and followed them prospectively until death or renal transplantation.…”

“…Naganuma et al [29] performed cranial MRI, including T2*-weighted MRI, on 179 hemodialysis patients with no past history of cerebrovascular events and followed them prospectively until death or renal transplantation. They showed that intracerebral hemorrhage occurred in only one of 134 (0.7 %) patients without cerebral microbleeds, whereas it occurred in 11 of 45 (24.4 %) patients with cerebral microbleeds during a median follow-up period of 5.0 years.…”