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Published on: October 2, 2020
The Characteristics of Intracerebral Hemorrhages in Dialysis Patients
Hiroki Karita1, Takumi Inaba1, Tomokazu Sekine2
1Department of Neurosurgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Insights
Patients on hemodialysis (HD) with intracerebral hemorrhage (ICH) face worse outcomes and higher hematoma enlargement risk. Dialysis and anticoagulants are key risk factors for enlargement in these patients.
Area of Science:
- Nephrology
- Neurology
- Critical Care Medicine
Background:
- Chronic kidney failure presents a global health challenge.
- Intracerebral hemorrhage (ICH) is more dangerous for hemodialysis (HD) patients.
- HD patients experience poorer prognoses following ICH.
Purpose of the Study:
- To investigate outcome disparities in ICH patients undergoing hemodialysis versus those not on HD.
- To identify demographic and clinical factors associated with adverse outcomes in ICH patients.
- To determine specific risk factors for hematoma enlargement in hemodialysis patients with ICH.
Main Methods:
- Retrospective analysis of 445 intracerebral hemorrhage cases.
- Comparison of 44 hemodialysis patients with 401 non-hemodialysis patients.
- Multivariate analyses to identify risk factors for adverse outcomes and hematoma enlargement.
Main Results:
- Hemodialysis patients were younger and had more comorbidities (hypertension, diabetes, smoking, stroke history) and anticoagulant use.
- Clinical outcomes were significantly worse in the hemodialysis group.
- Higher rates of hematoma enlargement were observed in hemodialysis patients, with dialysis and anticoagulants identified as risk factors.
Conclusions:
- Hemodialysis patients with ICH have a greater risk of hematoma enlargement and poorer clinical outcomes.
- Dialysis and anticoagulant use are significant risk factors for hematoma enlargement in ICH.
- Further prospective studies are needed to confirm these findings and guide clinical practice.
Background:
Chronic kidney failure is a global public health challenge and is associated with a higher risk of intracerebral hemorrhage (ICH). ICH is known to result in a poorer prognosis in hemodialysis (HD) patients than in non-HD patients.
Methods:
This retrospective study examined 445 consecutive cases of ICH to investigate the disparities in outcomes between HD (44 cases) and non-HD (401 cases) patients. The 2 groups were compared based on demographic and clinical factors, and multivariate analyses were performed to identify risk factors for adverse outcomes.
Results:
The HD group showed a significantly younger age (68.1 vs. 72.9, P = 0.01) and higher frequencies of hypertension, diabetes, anticoagulant use, a history of smoking, and a history of stroke. Clinical outcomes were worse in the HD group (P < 0.01). Detailed analysis of ICH characteristics revealed a higher rate of hematoma enlargement in the HD group (P < 0.01). Multivariate analysis confirmed dialysis and anticoagulant use as significant risk factors for hematoma enlargement.
Conclusions:
The study concludes that HD patients with ICH exhibit a higher risk of hematoma enlargement and poorer clinical outcomes. Dialysis and anticoagulant use emerged as significant risk factors for hematoma enlargement. Larger prospective studies are essential for validating these findings.
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