Cerebrovascular events in hemodialysis patients; a retrospective observational study

Abstract

BackgroundThis study reports findings in subjects who underwent brain imaging for any reason, and examined factors influencing cerebrovascular events (CVEs) in hemodialysis (HD) patients.MethodsWe reviewed the files of patients on HD between January 2015 and January 2018. A total of 432 patients who underwent HD for at least 5 months by the January 2015 and who were older than 18 years were included in the study; 264 had been examined by cerebral computed tomography or magnetic resonance imaging examination within the 3 years. Cerebrovascular pathology was detected in 139 of 264 patients.ResultsOf the 139 patients, 65 (24.62%) had ischemic lesions, 25 (9.47%) had hemorrhagic lesions, and 49 (18.56%) had cerebral small vessel disease (CSVD). We compared recorded data and later clinical findings between patients with and those without CVEs. The cause of end-stage renal disease was diabetes in 58.5% of patients with ischemic lesions, 52% in those with hemorrhagic lesions, and 55% in those with CSVD (P < 0.05). Patients with cerebrovascular ischemia were older (P = 0.0001) and had lower serum creatinine (sCr) (P = 0.0001) and higher serum C-reactive protein (CRP) (P = 0.002) levels than normal subjects. Hemorrhagic patients were older (P = 0.003) and had lower sCr (P = 0.003) and serum predialysis potassium (P = 0.003) and parathyroid hormone (PTH) (P = 0.004) levels than normal subjects. Patients with CSVD were older (P < 0.0001) and had lower sCr (P < 0.0001), phosphorus (P < 0.007), and PTH (P < 0.013) and higher CRP (P < 0.002) levels than normal subjects.ConclusionsHD patients with CVEs are older and typically have diabetes mellitus and lower sCr levels.

Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

“…One prospective cohort study evaluated the risk of hemorrhagic transformation in ischemic stroke [23]. A retrospective study showed hemorrhagic or ischemic stroke seen more in the elderly population [24]. Whereas a prospective study showed an increased risk of HT with the progression of renal dysfunction [23,25].…”

“…Whereas a prospective study showed an increased risk of HT with the progression of renal dysfunction [23,25]. Table 1 presents the risk of stroke in dialysis patients in relevant studies [17][18][19][20][21][22][23][24][25].…”

An Observational Cohort Study of the 2-Month Use of Regional Citrate Anticoagulation in Maintenance Hemodialysis Patients with Cerebral Hemorrhage

“…Compared with the general population, patients undergoing maintenance hemodialysis are at a higher risk of cerebral hemorrhage [ 15 ], which is associated with the high prevalence of hypertension, vascular comorbidities linked to kidney impairment, and complications resulting from uremia, such as vascular calcification and malnutrition-inflammation-atherosclerosis syndrome [ 16 ]. The use of heparin is essential for dialysis therapy, but is hazardous in the case of cerebral hemorrhage.…”

A High Serum Phosphate and Calcium-Phosphate Product is Associated With Cerebral Small Vascular Disease in Patients With Stroke; A Real World Study

“…A study in Taiwan shows that circulatory P levels > 3.925 mg/dL were associated with severe WMHs in a community-based longitudinal aging Study (Chung et al, 2019). A study in Turkey follows subjects who underwent brain imaging for any reason, reported that CSVD patients had lower P than normal subjects (Ozelsancak, Micozkadioglu, Torun, & Tekkarismaz, 2019). In US veterans population, high serum P is associated with CSVD and dementia, and this relationship is more signi cantly in participants <60 years old (Li, Xie, Bowe, Xian, & Al-Aly, 2017).…”