Maintenance hemodialysis independently increases the risk of early death after acute intracerebral hemorrhage.
BACKGROUND
It is unknown whether the clinical features and outcomes of intracerebral hemorrhage (ICH) patients who undergo maintenance hemodialysis (HD) at the time of ICH are similar to those of general ICH patients.


METHODS
We retrospectively examined the medical records of ICH patients admitted to the Stroke Center of Kawasaki Medical School Hospital within 7 days of ICH onset between April 2004 and June 2011. Patients were classed as HD or non-HD, and clinical characteristics were compared between the two groups. ICH volume was measured on admission CT and follow-up CT scan (< 24 h after admission). Hematoma enlargement was defined as a hematoma that increased by more than 33% of its initial volume. Early death was defined as all-cause death within 14 days of ICH onset. The factors associated with early death were determined using multivariate logistic regression analysis.


RESULTS
Five hundred and seven patients (320 males; 69.0 years old, interquartile range 59.0-79.0) were enrolled in the study. Thirty-six (7.2%) were receiving maintenance HD at the time of ICH and formed the HD group, and the remaining 471 patients formed the non-HD group. Use of antithrombotic agents prior to ICH was more common in the HD group than in the non-HD group (41.7 vs. 21.9%; p = 0.012). Brainstem (30.6 vs. 11.3%; p = 0.003) and lobar (19.4 vs. 6.6%; p = 0.013) hematoma locations were more common in the HD group than in the non-HD group. Enlargement of ICH volume was more common in the HD group than in the non-HD group (25.8 vs. 10.2%; p = 0.015). Early death was more common in the HD group than in the non-HD group (33.3 vs. 9.3%; p < 0.001). On the multivariate logistic regression analysis adjusted for age, sex and renal dysfunction, National Institutes of Health Stroke Scale score > 20 [odds ratio (OR) 27.40, 95% confidence interval (CI) 9.69-77.44; p < 0.001], ICH volume > 30 ml (OR 9.53, 95% CI 3.82-23.77; p < 0.001), HD (OR 6.42, 95% CI 1.39-29.76; p = 0.017), the use of antithrombotic agents (OR 3.04, 95% CI 1.22-7.56; p = 0.017) and glucose > 150 mg/dl (OR 2.51, 95% CI 1.01-6.26; p = 0.047) were independent factors associated with early death.


CONCLUSIONS
Maintenance HD is independently associated with early death in ICH patients.
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
Takashi
T
Shimoyama
Kazumi
K
Kimura
Kensaku
K
Shibazaki
Shinji
S
Yamashita
Yasuyuki
Y
Iguchi
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000032:analysis; D006406:Hematoma / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D019934:International Normalized Ratio; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D006442:Glycated Hemoglobin