Noriaki Sakamoto1, Eiichi Ishikawa2, Kazuyasu Aoki3, Yoji Uemae4, Yoji Komatsu1, Akira Matsumura5. 1. Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 2. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. Electronic address: e-ishikawa@md.tsukuba.ac.jp. 3. Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan; Department of Neurosurgery, Nerima Hikarigaoka Hospital, Tokyo, Japan. 4. Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan. 5. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Abstract
BACKGROUND: Chronic renal failure (CRF) is associated with a high incidence of stroke. In particular, the mortality rate for intracerebral hemorrhage (ICH) patients with hemodialysis (HD) due to advanced stage CRF is high, and the annual number of such cases is increasing. Therefore, we retrospectively investigated 5 years of clinical data from patients with ICH in our institution to reveal differences in the clinical courses of HD and non-HD patients and to identify risk factors for poor outcomes in ICH patients with HD. METHODS: Three hundred sixty-six consecutive patients with nontraumatic spontaneous ICH, 91% of whom did not receive HD (non-HD group) and 9% of whom received HD for the treatment of CRF (HD group), were enrolled. Clinical data, including the presence of intraventricular hemorrhage (IVH), microbleeds, modified Rankin scale scores, previous medical disease history, the presence of HD, and the days on which ICH occurred, were evaluated. RESULTS: In a comparison of HD patients and non-HD patients, the HD patients had higher rates of hematomas in the basal ganglia, IVH, use of antihypertensive drugs, antidiabetic drugs, and antiplatelet/anticoagulants. The mortality rate was higher in the HD group (44%) than in the non-HD group (21%). In the HD group, the risk factors associated with mortality were hematoma volume, the presence of IVH, and lack of antihypertensive drug use. Eighty-five percent of the ICH occurred on intermittent HD days or before the HD procedure on an HD day. CONCLUSIONS: Mortality in ICH patients with HD was associated with lack of antihypertensive drug use. Therefore, strict control of blood pressure is needed in HD patients to prevent ICH, especially on intermittent HD days or before the HD procedure.
BACKGROUND:Chronic renal failure (CRF) is associated with a high incidence of stroke. In particular, the mortality rate for intracerebral hemorrhage (ICH) patients with hemodialysis (HD) due to advanced stage CRF is high, and the annual number of such cases is increasing. Therefore, we retrospectively investigated 5 years of clinical data from patients with ICH in our institution to reveal differences in the clinical courses of HD and non-HDpatients and to identify risk factors for poor outcomes in ICHpatients with HD. METHODS: Three hundred sixty-six consecutive patients with nontraumatic spontaneous ICH, 91% of whom did not receive HD (non-HD group) and 9% of whom received HD for the treatment of CRF (HD group), were enrolled. Clinical data, including the presence of intraventricular hemorrhage (IVH), microbleeds, modified Rankin scale scores, previous medical disease history, the presence of HD, and the days on which ICH occurred, were evaluated. RESULTS: In a comparison of HDpatients and non-HDpatients, the HDpatients had higher rates of hematomas in the basal ganglia, IVH, use of antihypertensive drugs, antidiabetic drugs, and antiplatelet/anticoagulants. The mortality rate was higher in the HD group (44%) than in the non-HD group (21%). In the HD group, the risk factors associated with mortality were hematoma volume, the presence of IVH, and lack of antihypertensive drug use. Eighty-five percent of the ICH occurred on intermittent HD days or before the HD procedure on an HD day. CONCLUSIONS: Mortality in ICHpatients with HD was associated with lack of antihypertensive drug use. Therefore, strict control of blood pressure is needed in HDpatients to prevent ICH, especially on intermittent HD days or before the HD procedure.
Authors: Alireza Shirazian; Andres F Peralta-Cuervo; Maria P Aguilera-Pena; Louis Cannizzaro; Vi Tran; Doan Nguyen; Ifeanyi Iwuchukwu Journal: Neurocrit Care Date: 2021-01-05 Impact factor: 3.210