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Abstract: PO0843

Functional Prognosis Following Cerebral Hemorrhage in Patients on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Watanabe, Yusuke, Saitama Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Iruma-gun, Saitama, Japan
  • Inoue, Tsutomu, Saitama Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Iruma-gun, Saitama, Japan
  • Okada, Hirokazu, Saitama Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Iruma-gun, Saitama, Japan
Background

It has been reported that patients on hemodialysis have a higher morbidity and mortality for hypertensive cerebral hemorrhage. However, little is known about the functional outcomes in the surviving patients.

Methods

We retrospectively analyzed 62 consecutive patients on hemodialysis who developed hypertensive cerebral hemorrhage between 2016 and 2020. Patient background data, data on the clinical presentation of cerebral hemorrhage, and details of the lifesaving brain surgery (craniotomy for removal of hematoma and ventricular drainage) were reviewed. The outcomes examined were in-hospital mortality and Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), and Functional Independence Measure (FIM) scores at discharge.

Results

The median age of the patients was 66.5 years (interquartile range [IQR] 61.8–72.5). The median GCS score at admission was 13 (IQR, 6–14). Ventricular perforation was observed in 46.8% of patients. The median estimated hematoma volume was 26.9 mL (IQR, 7.7–69.6). The in-hospital mortality rate was 29.0%. Palliative care policy was selected by 16.1% of patients at admission, and 27.4% of patients underwent a lifesaving brain surgery. Compared with survivors, the non-survivors had a lower level of consciousness at admission (GCS score, median [IQR]: 4.5 [3–8] vs. 14 [11–14], respectively, p<0.001), higher rate of ventricular perforation (88.9% vs. 29.5%, p<0.001), and larger estimated hematoma volume (55.5 [29.6–124.5] vs. 16.3 [5.5–43.6] mL, respectively, p=0.003). After excluding patients with palliative care policy at admission, the ventricular perforation rate and estimated hematoma volume were higher in patients who underwent surgery than those who did not undergo surgery. Patients who underwent brain surgery had a lower level of consciousness, mRS score (median [IQR], 4.0 [3.0–4.0] vs. 5.0 [5.0–6.0], respectively p<0.001), and FIM score (18 [18–53.8] vs. 59 [20–84.5], respectively, p=0.009) at discharge than patients who did not undergo surgery.

Conclusion

In our single-center experience, a lower level of consciousness at admission, larger estimated hematoma volume, and ventricular perforation were associated with high mortality in patients on hemodialysis with cerebral hemorrhage. Survivors who underwent the lifesaving brain surgery had very poor functional outcomes at discharge.