Inflammatory Markers and Risk of Cerebrovascular Events in Patients Initiating Dialysis

Sozio, Stephen M.; Coresh, Josef; Jaar, Bernard G.; Fink, Nancy E.; Plantinga, Laura C.; Armstrong, Paige A.; Longenecker, J. Craig; Sharrett, A. Richey; Powe, Neil R.; Parekh, Rulan S.

doi:10.2215/cjn.08350910

Cited by 8 publications

(5 citation statements)

References 40 publications

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“…It has been reported that HD patients show a higher rate of silent cerebral infarctions, which is reflected by elevated CRP [18]. On the other hand, another report found no association between CRP level and risk of cerebrovascular events in HD patients [19].We observed that predialysis serum potassium concentration was lower in hemorrhagic stroke patients. A study in rats showed that a high potassium diet allowed cerebral arteries to withstand high blood pressure and reduced damage to the artery wall, thereby preventing brain hemorrhage and infarct and lowering mortality rate.…”

Section: Discussioncontrasting

confidence: 44%

Cerebrovascular events in hemodialysis patients; a retrospective observational study

Özelsancak¹,

Micozkadıoğlu

Torun

et al. 2019

Preprint

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Background: This study reports findings in subjects who underwent brain imaging for any reason, and examined factors influencing cerebrovascular events (CVEs) in hemodialysis (HD) patients. Methods: We 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. Results: Of 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. Conclusions: HD patients with CVEs are older and typically have diabetes mellitus and lower sCr levels.

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Section: Discussioncontrasting

confidence: 44%

Cerebrovascular events in hemodialysis patients; a retrospective observational study

Özelsancak¹,

Micozkadıoğlu

Torun

et al. 2019

Preprint

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“…There are several reasons why these analyses may have underestimated the true magnitude of any adverse effect of blood pressure in dialysis patients. First, measurement of blood pressure once a patient's kidney disease has progressed to require dialysis may not represent past exposure because: (a) blood pressure is modified by both dialysis and medication, and is generally treated to a guideline target (80% of US dialysis patients are prescribed at least one antihypertensive drug ); and (b) long‐standing hypertension (and other cardiovascular diseases) can lead to lower blood pressure by reducing cardiac contractility . The majority of incident dialysis patients have evidence of structural heart disease which worsens with increasing dialysis vintage .…”

Section: Stroke Risk Factorsmentioning

confidence: 99%

Evidence for the Prevention and Treatment of Stroke in Dialysis Patients

Herrington

Haynes

Staplin

et al. 2014

Seminars in Dialysis

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The risks of both ischemic and hemorrhagic stroke are particularly high in dialysis patients of any age and outcomes are poor. It is therefore important to identify strategies that safely minimize stroke risk in this population. Observational studies have been unable to clarify the relative importance of traditional stroke risk factors such as blood pressure and cholesterol in those on dialysis, and are affected by biases that usually make them an inappropriate source of data on which to base therapeutic decisions. Well-conducted randomized trials are not susceptible to such biases and can reliably investigate the causal nature of the association between a potential risk factor and the outcome of interest. However, dialysis patients have been under-represented in the cardiovascular trials which have proven net benefit of commonly used preventative treatments (e.g., antihypertensive treatments, low-dose aspirin, carotid revascularization, and thromboprophylaxis for atrial fibrillation), and there remains uncertainty about safety and efficacy of many of these treatments in this high-risk population. Moreover, the efficacy of renal-specific therapies that might reduce cardiovascular risk, such as modulators of mineral and bone disorder, online hemodiafiltration, and daily (nocturnal) hemodialysis, have not been tested in adequately powered trials. Recent trials have also demonstrated how widespread current practices could be causing stroke. Therefore, it is important that reliable information on the prevention and treatment of stroke (and other cardiovascular disease) in dialysis patients is generated by performing large-scale randomized trials of many current and future treatments.

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Section: Discussionmentioning

confidence: 99%

Cerebrovascular events in hemodialysis patients; a retrospective observational study

et al. 2019

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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.

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Inflammatory Markers and Risk of Cerebrovascular Events in Patients Initiating Dialysis

Cited by 8 publications

References 40 publications

Cerebrovascular events in hemodialysis patients; a retrospective observational study

Cerebrovascular events in hemodialysis patients; a retrospective observational study

Evidence for the Prevention and Treatment of Stroke in Dialysis Patients

Cerebrovascular events in hemodialysis patients; a retrospective observational study

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