Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
권호 표지

Clinical Assessment of Risk Factors for the Intracerebral Hemorrhage in Patients with Chronic Renal Failure

  • Byun, Hyoung-Soo (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Kim, Choong-Hyun (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Cheong, Jin-Hwan (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Kim, Jae-Min (Department of Neurosurgery, Hanyang University Guri Hospital)
  • Published : 2010.06.30
⟨ Previous Next ⟩

Abstract

Objective : Cerebrovascular and cardiovacular diseases are the main causes of death in patients with chronic renal failure (CRF) and who are undergoing hemodialysis. We investigated the risk factors for the development of intracerbral hemorrhage (ICH) in this population. Methods : We retrospectively reviewed a total of 53 patients who underwent hemodialysis for CRF and who developed ICH. The patients' demographics, including gender and age, the duration of the hemodialysis, the initial Glasgow Coma Scale (GCS) score, the underlying causes of CRF, the past medication history, the location and amount of hemorrhage and the therapeutic modality for ICH were analyzed. Results : The development of ICH significantly increased in the old age patients ($\geq$ 65 years), the patients with a prolonged history of hemodialysis ($\geq$ 5 years) and the patients with hypertension (p < 0.05). However, gender, anemia (hemoglobin $\leq$ 8.0 g/dl) and the initial systolic blood pressure ($\geq$ 180 mmHg) were not significantly correlated with the occurrence of intracerebral hemorrhage in the hemodialyzed patients. Conclusion : The present study suggests that the development of ICH in patients with CRF is increased in the old age patients, the patients with a prolonged history of hemodialysis and the medically co-morbid patients. To avoid this disastrous complication, we should try to minimize the modifiable risk factors of hemorrhagic stroke in CRF patients.

Keywords

References

  1. Akizawa T, Koshikawa S, Ota K, Kazama M, Mimura N, Hirasawa Y. Nafamostat mesilate: a regioinal anticoagulant for hemodialysis in patients at high risk for bleeding. Nephron 64:376-81, 1993 https://doi.org/10.1159/000187357
  2. Amann K, Neususs R, Ritz E, Irzyniec T, Wiest G, Mall G. Changes of vascular architecture-independent of blood pressure in experimental uremia. Am J Hypertens 8:409-17, 1995 https://doi.org/10.1016/0895-7061(94)00248-A
  3. Goodman WG, Goldin J, KuizonBD, Yoon C, Gales B, Sider D, et al. Coronary artery calcification in young adults with endstage renal disease who are undergoing dialysis. N Engl J Med 342:1478-83, 2000 https://doi.org/10.1056/NEJM200005183422003
  4. Guldener C, Lambert J, Janssen MJ, Donker AJ, Stehouwer CD. Endothelium-dependent vasodilatation and distensibility of large arteries in chronic haemodialysis patients. Nephrol Dial Transplant 12:14-8, 1997
  5. HY Song, YS Park, SW Kang, KH Choi, SK Ha, DS Han. The Causes of Early Death in End-stage Renal Disease Patients. Korean J Nephrol 21:645-51, 2002
  6. Ibels LS, Alfrey AC, Huffer WE, Craswell PW, Anderson JT, Weil R 3rd. Arterial calcification and pathology in uremic patients undergoing dialysis. Am J Med 66:790-6, 1979 https://doi.org/10.1016/0002-9343(79)91118-5
  7. Iseki K, Fukiyama K. Clinical demographics and long term prognosis after stroke on patients in chronic hemodialysis. The Okinawa Dialysis Study (OKIDS) Group. Nephrol Dial Transplant 15:1808-13, 2000 https://doi.org/10.1093/ndt/15.11.1808
  8. Iseki K, Fukiyama K. Predictors of stroke in patients receiving chronic hemodialysis. Kidney Int 50:1672-5, 1996 https://doi.org/10.1038/ki.1996.484
  9. Iseki K, Kinjo K, Kimura Y, Osawa A, Fukijama K. Evidence for high risk of cerebral hemorrhage in chronic dialysis patients. Kidney Int 44:1086-90, 1993 https://doi.org/10.1038/ki.1993.352
  10. Kawabata N. Brain hemorrhage associated with maintenance of hemodialysis - CT analysis of 19 cases. No Socchu 16:79-86, 1994
  11. Kawagishi T, Nishizawa Y, Konishi T, Kawasaki K, Emoto M, Shoji T, et al. High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia. Kidney Int 48:820-6, 1995 https://doi.org/10.1038/ki.1995.356
  12. Kawamura M, Fijimoto S, Hisanaga S, Yamamoto Y, Eto T. Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis. Am J Kidney Dis 31:991-6, 1998 https://doi.org/10.1053/ajkd.1998.v31.pm9631844
  13. Kennedy R, Case C, Fathi R, Johnson D, Isbel N, Marwick TH. Does renal failure cause an atherosclerotic milieu in patients with end- stage renal disease? Am J Med 110:198-204, 2001 https://doi.org/10.1016/S0002-9343(00)00695-1
  14. Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 290:697-701, 1974 https://doi.org/10.1056/NEJM197403282901301
  15. London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, et al. Cardiac and arterial interactions in end-stage renal disease. Kidney Int 50:600-8, 1996 https://doi.org/10.1038/ki.1996.355
  16. Longenecker JC, Coresh J, Power NR, Levey AS, Fink NE, Martin A, et al. Traditional Cardiovascular Disease Risk Factors in Dialysis Patients Compared with the General Population: The CHOICE Study. J Am Soc Nephrol 13:1918- 27, 2002 https://doi.org/10.1097/01.ASN.0000019641.41496.1E
  17. Muntner P, Coresh J, Klag MJ, Whelton PK, Perneger TV. History of myocardial infarction and stroke among incident end-stage renal disease cases and population-based controls: An analysis of shared risk factors. Am J Kidney Dis 40:323-30, 2002 https://doi.org/10.1053/ajkd.2002.34515
  18. Murakami M, Hamasaki T, Kimura S, Maruyama D, Kakita K. Clinical features and management of intracranial hemorrhage in patients undergoing maintenance dialysis therapy. Neurol Med Chir (Tokyo) 44(5):225-32, 2004 https://doi.org/10.2176/nmc.44.225
  19. Savage T, Clarke AL, Giles M, Tomson CR, Raine AE. Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease. Nephrol Dial Transplant 13:2004-12, 1998 https://doi.org/10.1093/ndt/13.8.2004
  20. Shoji T, Emoto M, Tabata T, Kimoto E, Shinohara K, Maekawa K, et al. Advanced atherosclerosis in predialysis patients with chronic renal failure. Kidney Int 61:2187-92, 2002 https://doi.org/10.1046/j.1523-1755.2002.00372.x
  21. Shoji T, Nishizawa Y, Kawagishi T, Kawasaki K, Taniwaki H, Tabata T, et al. Intermediate-density lipoprotein as an independent risk factor for aortic atherosclerosis in hemodialysis patients. J Am Soc Nephrol 9:1277-84, 1998
  22. Siddiqui JY, Fitz AE, Lawton RL, Kirkendall WM. Cause of death in patients receiving long-term hemodialysis. JAMA 212:1350-4, 1970 https://doi.org/10.1001/jama.212.8.1350
  23. YS Kim. Renal Replacement Therapy in Korea -Insan Memorial Dialysis Registry 2001-. Korean J Nephrol 20 (Suppl 1): S1-S2, 2001
  24. Zoungas S, Ristevski S, Lightfoot P, Liang YL, Branley P, Shiel LM, et al. Carotid artery intimamedial thickness is increased in chronic renal failure. Clin Exp Pharmacol Physiol 27:639-41, 2000 https://doi.org/10.1046/j.1440-1681.2000.03301.x