title: Clinical outcomes of intracerebral hemorrhage in hemodialysis patients.
abstract: BACKGROUND
  Chronic renal failure (CRF) is associated with a high incidence of stroke. In particular, the mortality rate for intracerebral hemorrhage (ICH) patients with hemodialysis (HD) due to advanced stage CRF is high, and the annual number of such cases is increasing. Therefore, we retrospectively investigated 5 years of clinical data from patients with ICH in our institution to reveal differences in the clinical courses of HD and non-HD patients and to identify risk factors for poor outcomes in ICH patients with HD.
  
  
  METHODS
  Three hundred sixty-six consecutive patients with nontraumatic spontaneous ICH, 91% of whom did not receive HD (non-HD group) and 9% of whom received HD for the treatment of CRF (HD group), were enrolled. Clinical data, including the presence of intraventricular hemorrhage (IVH), microbleeds, modified Rankin scale scores, previous medical disease history, the presence of HD, and the days on which ICH occurred, were evaluated.
  
  
  RESULTS
  In a comparison of HD patients and non-HD patients, the HD patients had higher rates of hematomas in the basal ganglia, IVH, use of antihypertensive drugs, antidiabetic drugs, and antiplatelet/anticoagulants. The mortality rate was higher in the HD group (44%) than in the non-HD group (21%). In the HD group, the risk factors associated with mortality were hematoma volume, the presence of IVH, and lack of antihypertensive drug use. Eighty-five percent of the ICH occurred on intermittent HD days or before the HD procedure on an HD day.
  
  
  CONCLUSIONS
  Mortality in ICH patients with HD was associated with lack of antihypertensive drug use. Therefore, strict control of blood pressure is needed in HD patients to prevent ICH, especially on intermittent HD days or before the HD procedure.
authors.affiliation: Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. Electronic address: e-ishikawa@md.tsukuba.ac.jp.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishikawa
authors.affiliation: Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan; Department of Neurosurgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.
authors.forename: Kazuyasu
authors.initials: K
authors.lastname: Aoki
authors.affiliation: Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Uemae
authors.affiliation: Department of Neurosurgery, Hitachi General Hospital, Ibaraki, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000401:mortality*; D002648:Child; D005260:Female; D006406:Hematoma / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents
keywords: Chronic renal failure; Hemodialysis; Hypertension; Intracerebral hemorrhage