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Predictors of stroke in patients receiving chronic hemodialysis
1Dialysis Unit, University of The Ryukyus, Okinawa, Japan.
Insights
Hypertension is a significant risk factor for stroke in patients undergoing maintenance hemodialysis. Tightly controlling blood pressure is crucial for preventing stroke in this vulnerable population.
Area of Science:
- Nephrology
- Neurology
- Cardiovascular Medicine
Background:
- Patients with end-stage renal disease (ESRD) on maintenance hemodialysis face elevated risks for cerebrovascular events.
- Stroke incidence is notably higher in individuals with chronic kidney disease requiring renal replacement therapy.
Purpose of the Study:
- To ascertain the specific risk factors contributing to stroke development in patients undergoing maintenance hemodialysis.
- To evaluate the association between hypertension and stroke occurrence in this patient cohort.
Main Methods:
- A prospective study design was employed, enrolling 1,243 patients on maintenance hemodialysis in Okinawa, Japan.
- Data from medical records were collected as of January 1, 1991, with stroke occurrences meticulously documented until December 31, 1995.
- Multiple logistic regression analysis was utilized to identify independent predictors of stroke.
Main Results:
- A total of 90 stroke cases were recorded over 5,110.3 patient-years.
- Cerebral hemorrhage was the most common type (70.0%), followed by cerebral infarction (22.2%) and subarachnoid hemorrhage (7.8%).
- Hypertension emerged as a significant independent predictor of stroke, exhibiting an odds ratio of 2.38 (95% CI: 1.26–4.50).
Conclusions:
- The study confirms hypertension as a key modifiable risk factor for stroke in maintenance hemodialysis patients.
- Inadequate hypertension management significantly contributes to the high stroke incidence observed in this population.
- Aggressive blood pressure control strategies are strongly recommended for chronic dialysis patients to mitigate stroke risk.
Abstract:
To identify the risk factors of stroke in patients receiving maintenance hemodialysis, we conducted a prospective study on patients in Okinawa, Japan. Patients with end-stage renal disease who were treated with maintenance hemodialysis before the end of 1990 and were alive on January 1, 1991 (N = 1,243) were studied. Medical records and pertinent data as of January 1, 1991 were compiled. All occurrences of stroke were recorded throughout the follow-up period, and until the end of 1995. The duration of observation was 5,110.3 patient-years. A total of 90 cases of stroke were observed, including 63 (70.0%) cerebral hemorrhage, 20 (22.2%) cerebral infarction, and 7 (7.8%) subarachnoid hemorrhage. Multiple logistic analysis identified hypertension as an independent predictor of stroke, with an odds ratio of 2.38 and a 95% confidence interval from 1.26 to 4.50. The present study demonstrates that the high incidence of stroke is at least partially explained by insufficient control of hypertension. Every effort to control hypertension is warranted in chronic dialysis patients.