Related Experiment Videos
Evidence for high risk of cerebral hemorrhage in chronic dialysis patients
1Third Department of Internal Medicine, School of Medicine, University of The Ryukyus, Okinawa, Japan.
Insights
Patients on chronic dialysis face significantly higher risks of stroke and acute myocardial infarction compared to the general population. Cerebral hemorrhage is particularly prevalent, highlighting the need for blood pressure control and nutritional support.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Epidemiology
Background:
- Cardiovascular disease accounts for half of deaths in chronic dialysis patients.
- Precise incidence and relative risk of cardiovascular disease in dialysis patients are not well-established.
- Understanding these risks is crucial for patient management.
Purpose of the Study:
- To determine the annual incidence of cardiovascular disease in chronic dialysis patients.
- To calculate the relative risk of cardiovascular events in dialysis patients compared to the general population.
- To identify factors associated with increased cardiovascular risk in this population.
Main Methods:
- Prospective study of 1,609 chronic dialysis patients and 1.2 million general population individuals in Okinawa, Japan (1988-1991).
- Diagnosis of stroke via symptoms and CT scan; acute myocardial infarction via ECG and serum enzymes.
- Relative risk calculated using standardized morbidity rates by sex and age group.
Main Results:
- Incidence per 1,000 person-years: 11.5 for stroke, 1.1 for acute myocardial infarction.
- Relative risks compared to normals: 5.2 for stroke, 2.1 for acute myocardial infarction.
- Cerebral hemorrhage showed a markedly elevated relative risk (10.7) and occurred 10 years younger in dialysis patients, linked to hypertension and low albumin/cholesterol.
Conclusions:
- Chronic dialysis patients have a substantially elevated risk of stroke and acute myocardial infarction.
- Cerebral hemorrhage is a significant concern in dialysis patients, associated with hypertension and poor nutritional markers.
- Emphasis on blood pressure control and nutritional status is vital for managing cardiovascular risk in chronic dialysis.
Abstract:
One-half of the total deaths in chronic dialysis patients are due to cardiovascular disease; however, the precise incidence and relative risk of those compared to normals are not known. Therefore, we sought to determine the annual incidence of cardiovascular disease and relative risk of those on chronic dialysis to the general population. Both the general population (1.2 million, Census 1990) and chronic dialysis patients (N = 1,609) in Okinawa, Japan were studied prospectively from April, 1988, to March, 1991. Diagnosis of stroke was made by symptoms and brain CT scan, and acute myocardial infarction was done by changes in electrocardiogram and serum enzymes. The relative risk (observed/expected ratio) was calculated by using the standardized morbidity rate obtained in both sexes and age-class every 10 years in the general population. Forty-one stroke (8 cerebral infarction, 31 cerebral hemorrhage, and 2 subarachnoid hemorrhage) and four acute myocardial infarction cases were registered during the study period in chronic dialysis patients. The incidence per 1,000 person-year was 11.5 in stroke, 2.2 in cerebral infarction, 8.7 in cerebral hemorrhage, 0.6 in subarachnoid hemorrhage, and 1.1 in acute myocardial infarction. The relative risk compared to normals was 5.2 in stroke, 2.0 in cerebral infarction, 10.7 in cerebral hemorrhage, 4.0 in subarachnoid hemorrhage, and 2.1 in acute myocardial infarction. Cerebral hemorrhage occurred at 10 years younger than that of the general population (P < 0.001) and was associated with high prevalence of hypertension and low levels of serum albumin and cholesterol. Our results confirm the importance of blood pressure control and nutritional status in chronic dialysis patients.