Abstract 2434: Maintenance Hemodialysis In Patients With Acute Intracerebral Hemorrhage Is Associated With Early Stroke Death.

Abstract

Background: Patients with end-stage renal disease (ESRD) are associated with markedly higher risk of stroke and poor outcome. However, few studies have reported the detailed clinical features including patient outcome of acute intracerebral hemorrhage (ICH) in patients with maintenance hemodialysis (HD). Methods: From April 2004 to June 2011, we enrolled consecutive patients with acute ICH within 7 days onset. All patients had detailed clinical characteristics including patient outcome, blood tests, and CT scan. ICH volume was measured on admission CT and follow-up CT (<24hr after admission) scan. Hematoma enlargement was defined as a hematoma that increased more than 33% of its initial volume. We divided all patients into HD group and non-HD group, and compared clinical characteristics between the two groups. Next, the factors associated with early stroke death within 14 days of onset were investigated by multivariate logistic regression analysis. Results: 507 consecutive patients (320 males, 68.6±12.9 years old) were enrolled in the present study. 36 patients (7.2%) were receiving maintenance HD. HD group was younger (60.7±13.4 years vs. 69.2±12.7 years, P<0.001) and more frequently had diabetes (52.8 % vs. 17.8 %, P<0.001) than non-HD group. Prior antithrombotic agents were more used in HD group than non-HD group (41.7% vs. 21.9%, P=0.012). There was no significant difference in NIHSS score (16.3±11.6 vs. 13.1±9.0, P=0.114) and ICH volume on admission (24.4±34.1 ml vs. 17.8±32.1 ml, P=0.347). However, ICH volume enlargement was more frequently seen in HD group than non-HD group (25.8 % vs. 10.2 %, P=0.015). With respect to the hematoma location, brainstem (30.6% vs. 11.3%, P=0.003) and lobar (19.4% vs. 6.6%, P=0.013) were more frequently found in HD group than non-HD group. Early stroke death was more frequently observed in HD group than non-HD group (33.3% vs. 9.3%, P<0.001). On multivariate logistic regression analysis, NIHSS score ≥22 (OR 43.95; 95% CI, 13.46-143.50, P<0.001), ICH volume≥18ml (OR 4.55; 95% CI, 1.80-11.50, P=0.001), prior antithrombotic agents (OR 4.61; 95% CI, 1.70-12.56, P=0.003), HD (OR 6.95; 95% CI, 1.61-30.07, P=0.010),and plasma glucose level≥160 mg/dl (OR 2.56; 95%CI, 1.02-6.43, P=0.046) were independent factors associated with early stroke death. Conclusion: ICH patients on maintenance HD were independently associated with early stroke death.