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Maintenance hemodialysis independently increases the risk of early death after acute intracerebral hemorrhage.
Cerebrovasc Dis. 2013; 36(1):47-54.CD

Abstract

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.

CONCLUSION

Maintenance HD is independently associated with early death in ICH patients.

Authors+Show Affiliations

Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23921070

Citation

Shimoyama, Takashi, et al. "Maintenance Hemodialysis Independently Increases the Risk of Early Death After Acute Intracerebral Hemorrhage." Cerebrovascular Diseases (Basel, Switzerland), vol. 36, no. 1, 2013, pp. 47-54.
Shimoyama T, Kimura K, Shibazaki K, et al. Maintenance hemodialysis independently increases the risk of early death after acute intracerebral hemorrhage. Cerebrovasc Dis. 2013;36(1):47-54.
Shimoyama, T., Kimura, K., Shibazaki, K., Yamashita, S., & Iguchi, Y. (2013). Maintenance hemodialysis independently increases the risk of early death after acute intracerebral hemorrhage. Cerebrovascular Diseases (Basel, Switzerland), 36(1), 47-54. https://doi.org/10.1159/000351504
Shimoyama T, et al. Maintenance Hemodialysis Independently Increases the Risk of Early Death After Acute Intracerebral Hemorrhage. Cerebrovasc Dis. 2013;36(1):47-54. PubMed PMID: 23921070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maintenance hemodialysis independently increases the risk of early death after acute intracerebral hemorrhage. AU - Shimoyama,Takashi, AU - Kimura,Kazumi, AU - Shibazaki,Kensaku, AU - Yamashita,Shinji, AU - Iguchi,Yasuyuki, Y1 - 2013/07/30/ PY - 2012/09/11/received PY - 2013/04/10/accepted PY - 2013/8/8/entrez PY - 2013/8/8/pubmed PY - 2014/4/17/medline SP - 47 EP - 54 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc Dis VL - 36 IS - 1 N2 - 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. CONCLUSION: Maintenance HD is independently associated with early death in ICH patients. SN - 1421-9786 UR - https://www.unboundmedicine.com/medline/citation/23921070/Maintenance_hemodialysis_independently_increases_the_risk_of_early_death_after_acute_intracerebral_hemorrhage_ L2 - https://www.karger.com?DOI=10.1159/000351504 DB - PRIME DP - Unbound Medicine ER -