Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis
BackgroundIn patients undergoing hemodialysis, intracerebral hemorrhage (ICH) is the main cause of mortality among stroke subtypes. It is unclear whether, along with traditional cardiovascular risk factors, the risk factors unique to the uraemic environment, such as the abnormal metabolism of intact...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1111865/full |
| _version_ | 1797865936282189824 |
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| author | Song Yu-Huan Cai Guang-Yan Xiao Yue-Fei |
| author_facet | Song Yu-Huan Cai Guang-Yan Xiao Yue-Fei |
| author_sort | Song Yu-Huan |
| collection | DOAJ |
| description | BackgroundIn patients undergoing hemodialysis, intracerebral hemorrhage (ICH) is the main cause of mortality among stroke subtypes. It is unclear whether, along with traditional cardiovascular risk factors, the risk factors unique to the uraemic environment, such as the abnormal metabolism of intact parathyroid hormone (iPTH), can contribute to the risk of ICH in these patients.MethodsThis retrospective case–control study included 25 patients undergoing hemodialysis with ICH at a single center between 30 June 2015 and 10 October 2022. The controls were 95 patients undergoing maintenance hemodialysis treated at the same dialysis center in July 2020. We compared the characteristics of patients with ICH with those of the control group to identify factors that contributed to the development of ICH.ResultsIntracerebral hemorrhage (ICH) was located in the basal ganglia (14/25), cerebellum (6/25), and brainstem (6/25) in 25 patients. A total of 17 patients died in the first 16 days due to neurological complications. Univariate analysis showed significant differences in systolic BP, diastolic BP, iPTH, and alkaline phosphatase between the two groups (p < 0.05). Multivariate logistic regression analysis showed that higher systolic BP (OR, 1.053; 95% CI, 1.018–1.090; p = 0.003) and higher iPTH (OR, 1.007; 95% CI, 1.003–1.012; p = 0.001) were associated with the onset of ICH. ICH was predicted by systolic BP and iPTH by receiver operating characteristic (ROC) curve analysis, with areas under the curve (AUCs) of 0.732 and 0.624, respectively. The optimal cutoffs for systolic BP and iPTH were 151.9 mmHg and 295.4 pg./ml, respectively. Restricted cubic spline showed that the shape of the association of iPTH with the risk of ICH was approximately J-shaped (P for non-linearity <0.05).ConclusionHigher systolic BP and abnormal iPTH metabolism might be associated with ICH in patients undergoing hemodialysis. Comprehensive control of hypertension and iPTH may be a fundamental preventive strategy for ICH in these patients. |
| first_indexed | 2024-04-09T23:16:09Z |
| format | Article |
| id | doaj.art-3358619e7b744a3580f05aec65b88118 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T23:16:09Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-3358619e7b744a3580f05aec65b881182023-03-22T06:13:51ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-03-011410.3389/fneur.2023.11118651111865Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysisSong Yu-Huan0Cai Guang-Yan1Xiao Yue-Fei2Department of Nephrology, Aerospace Center Hospital, Beijing, ChinaDepartment of Nephrology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Beijing, ChinaDepartment of Nephrology, Aerospace Center Hospital, Beijing, ChinaBackgroundIn patients undergoing hemodialysis, intracerebral hemorrhage (ICH) is the main cause of mortality among stroke subtypes. It is unclear whether, along with traditional cardiovascular risk factors, the risk factors unique to the uraemic environment, such as the abnormal metabolism of intact parathyroid hormone (iPTH), can contribute to the risk of ICH in these patients.MethodsThis retrospective case–control study included 25 patients undergoing hemodialysis with ICH at a single center between 30 June 2015 and 10 October 2022. The controls were 95 patients undergoing maintenance hemodialysis treated at the same dialysis center in July 2020. We compared the characteristics of patients with ICH with those of the control group to identify factors that contributed to the development of ICH.ResultsIntracerebral hemorrhage (ICH) was located in the basal ganglia (14/25), cerebellum (6/25), and brainstem (6/25) in 25 patients. A total of 17 patients died in the first 16 days due to neurological complications. Univariate analysis showed significant differences in systolic BP, diastolic BP, iPTH, and alkaline phosphatase between the two groups (p < 0.05). Multivariate logistic regression analysis showed that higher systolic BP (OR, 1.053; 95% CI, 1.018–1.090; p = 0.003) and higher iPTH (OR, 1.007; 95% CI, 1.003–1.012; p = 0.001) were associated with the onset of ICH. ICH was predicted by systolic BP and iPTH by receiver operating characteristic (ROC) curve analysis, with areas under the curve (AUCs) of 0.732 and 0.624, respectively. The optimal cutoffs for systolic BP and iPTH were 151.9 mmHg and 295.4 pg./ml, respectively. Restricted cubic spline showed that the shape of the association of iPTH with the risk of ICH was approximately J-shaped (P for non-linearity <0.05).ConclusionHigher systolic BP and abnormal iPTH metabolism might be associated with ICH in patients undergoing hemodialysis. Comprehensive control of hypertension and iPTH may be a fundamental preventive strategy for ICH in these patients.https://www.frontiersin.org/articles/10.3389/fneur.2023.1111865/fullintracerebral hemorrhagehemodialysisparathyroid hormonerisk factorsecondary hyperparathyroidism |
| spellingShingle | Song Yu-Huan Cai Guang-Yan Xiao Yue-Fei Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis Frontiers in Neurology intracerebral hemorrhage hemodialysis parathyroid hormone risk factor secondary hyperparathyroidism |
| title | Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis |
| title_full | Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis |
| title_fullStr | Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis |
| title_full_unstemmed | Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis |
| title_short | Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis |
| title_sort | risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis |
| topic | intracerebral hemorrhage hemodialysis parathyroid hormone risk factor secondary hyperparathyroidism |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1111865/full |
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