title: Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients.
abstract: OBJECTIVE
  In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients.
  
  
  METHODS
  Cranial MRI, including T2*-weighted magnetic resonance imaging, was performed on 179 hemodialysis patients with no past history of cerebrovascular events. The patients were followed prospectively until death or renal transplantation. We used the Cox proportional hazards model with inverse probability of treatment weighting using the propensity score to compare the event-free survivals of patients with/without CMBs. For sensitivity analyses, stratification by propensity score quintile and regression adjustment were used.
  
  
  RESULTS
  CMBs were detected in 45 of the 179 patients. During a median follow-up period of 5.0 years, stroke occurred in 24 patients, including 12 with intracerebral hemorrhage and 12 with cerebral infarctions. Cox proportional hazards analysis with inverse probability of treatment weighting using the propensity score revealed that the presence of CMBs was a strong and significant predictor of intracerebral hemorrhage (hazard ratio, 26.53; 95% confidence interval, 2.88-244.90) but not cerebral infarction (hazard ratio, 0.91; 95% confidence interval, 0.25-3.34). Sensitivity analyses yielded similar results.
  
  
  CONCLUSIONS
  This study showed that the presence of CMBs was an independent and strong predictor of intracerebral hemorrhage in stroke-free hemodialysis patients, indicating that hemodialysis patients with CMBs should be carefully monitored for future onset of intracerebral hemorrhage.
authors.affiliation: From the Department of Urology (T. Naganuma, Y.T., T. Nakatani), Department of Geriatrics and Vascular Medicine (T.S.), Department of Nephrology (E.I.), Osaka City University Graduate School of Medicine, Osaka, Japan; and Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan (M.O.). spxd48k9@aria.ocn.ne.jp.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: From the Department of Urology (T. Naganuma, Y.T., T. Nakatani), Department of Geriatrics and Vascular Medicine (T.S.), Department of Nephrology (E.I.), Osaka City University Graduate School of Medicine, Osaka, Japan; and Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan (M.O.).
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takemoto
authors.affiliation: From the Department of Urology (T. Naganuma, Y.T., T. Nakatani), Department of Geriatrics and Vascular Medicine (T.S.), Department of Nephrology (E.I.), Osaka City University Graduate School of Medicine, Osaka, Japan; and Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan (M.O.).
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.affiliation: From the Department of Urology (T. Naganuma, Y.T., T. Nakatani), Department of Geriatrics and Vascular Medicine (T.S.), Department of Nephrology (E.I.), Osaka City University Graduate School of Medicine, Osaka, Japan; and Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan (M.O.).
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.affiliation: From the Department of Urology (T. Naganuma, Y.T., T. Nakatani), Department of Geriatrics and Vascular Medicine (T.S.), Department of Nephrology (E.I.), Osaka City University Graduate School of Medicine, Osaka, Japan; and Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan (M.O.).
authors.forename: Mikio
authors.initials: M
authors.lastname: Okamura
authors.affiliation: From the Department of Urology (T. Naganuma, Y.T., T. Nakatani), Department of Geriatrics and Vascular Medicine (T.S.), Department of Nephrology (E.I.), Osaka City University Graduate School of Medicine, Osaka, Japan; and Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan (M.O.).
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000378:metabolism* / Q000628:therapy; D002560:Cerebrovascular Circulation; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects / Q000639:trends*; D055815:Young Adult
keywords: cerebral hemorrhage; cerebral microbleeds; dialysis; magnetic resonance imaging; stroke