Stroke in patients on maintenance hemodialysis: a 22-year single-center study.
BACKGROUND
Few studies have reported the detailed clinical features of stroke in patients with end-stage renal disease. We examined the frequency of the subtypes, mechanism, and outcome of stroke in patients receiving hemodialysis (HD).


METHODS
We studied 151 consecutive patients who developed an acute stroke among the maintenance HD population in our kidney center during 22 years, divided into the initial 17-year (n = 61) and the more recent 5-year (n = 90) groups. For purposes of comparison, we also studied 1,017 stroke patients with normal renal function.


RESULTS
Stroke patients receiving HD were younger (age, 64 +/- 10 versus 67 +/- 13 years; P < 0.02) and more frequently had hypertension (87% versus 43%; P < 0.0001) and diabetes (53% versus 23%; P < 0.0001) compared with stroke patients with normal renal function. In the initial HD group, brain hemorrhage was the major subtype of stroke (52%), whereas in the more recent group, brain infarction (BI) replaced hemorrhage as the leading subtype (68%; P < 0.005). In patients with BI, large-artery atherosclerosis was more prevalent in the more recent group than in the initial HD group (33% versus 12%; P < 0.05). A vertebrobasilar territory infarct was more prevalent for HD patients than for those with normal renal function (48% versus 33%; P < 0.05). BI (especially large-artery atherosclerosis and cardioembolism) occurred more frequently during or less than 30 minutes after the dialysis procedure (34%) than brain hemorrhage (19%; P < 0.05). Receiving HD was an independent indicator for poor functional outcome and mortality after stroke.


CONCLUSIONS
In our maintenance HD population, stroke showed several unique characteristics compared with the control population, including a predominance of vertebrobasilar arterial territory infarcts. The dialysis procedure itself seems to be associated more frequently with ischemic rather than hemorrhagic strokes.
Toyoda
Kazunori
K
Stroke Center, Department of Neurosurgery, Fukuoka Red Cross Hospital, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. toyoda@qmed.hosp.go.jp
Fujii
Kenichiro
K
Fujimi
Satoru
S
Kumai
Yasuhiro
Y
Tsuchimochi
Hirohito
H
Ibayashi
Setsuro
S
Iida
Mitsuo
M
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014715:Vertebrobasilar Insufficiency / Q000453:epidemiology