Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int Urol Nephrol. 2019 Aug;51(8):1435-1441. doi: 10.1007/s11255-019-02218-x. Epub 2019 Jul 1.
The incidence of stroke in patients undergoing hemodialysis (HD) is eight-to-ten times greater than that of the general population. However, data on the outcome of stroke in these patients are limited.
In this retrospective observational cohort study, electronic medical records of all patients undergoing HD from 1.1.2014 to 31.12.2017 at Meir Medical Center, Israel, were reviewed. Stroke was defined as a focal neurological deficit of cerebrovascular origin, and confirmed as ischemic or hemorrhagic by computed tomography. Age- and sex-matched HD patients who did not experience a stroke (HD-NS) and hospitalized stroke patients with normal kidney function (NRF-S) served as the two control groups. Baseline demographic, clinical, and laboratory data were collected. Thrombolytic therapy, duration of hospital stay, and mortality were recorded. Functional status at discharge was assessed by the Modified Rankin Scale.
In the cohort study group (HD-S), 52 strokes occurred during 248.3 patient years, an incidence rate of 8.13%, and a stroke rate of 0.19% patients/month. Most strokes in HD patients were ischemic, and only four patients were administered tissue plasminogen activator. HD-S had longer hospitalization than did NRF-S (10.6 ± 9.9 vs. 5.96 ± 5.3 days, p = 0.004) and lower functional status at discharge (Rankin score 3.75 ± 1.57 vs. 2.29 ± 1.89, p < 0.001). HD-S patients had a higher mortality than both HD-NS and NRF-S patients.
Stroke outcome in these patients is dismal with prolonged hospital stay, poor functional status at discharge, very limited response to rehabilitation, and increased mortality.
接受血液透析（HD）的患者发生中风的几率是普通人群的 8 到 10 倍。然而，关于这些患者中风结果的数据有限。
在这项回顾性观察队列研究中，回顾了以色列梅尔医疗中心 2014 年 1 月 1 日至 2017 年 12 月 31 日期间所有接受 HD 的患者的电子病历。中风定义为血管源性局灶性神经功能缺损，并通过计算机断层扫描确认为缺血性或出血性。未发生中风的年龄和性别匹配的 HD 患者（HD-NS）和肾功能正常的住院中风患者（NRF-S）作为两个对照组。收集了基线人口统计学、临床和实验室数据。记录溶栓治疗、住院时间和死亡率。出院时的功能状态通过改良 Rankin 量表进行评估。
在队列研究组（HD-S）中，248.3 患者年中发生 52 例中风，发病率为 8.13%，中风率为 0.19%/患者/月。大多数 HD 患者的中风为缺血性，仅有 4 名患者接受了组织型纤溶酶原激活剂治疗。HD-S 的住院时间长于 NRF-S（10.6±9.9 天比 5.96±5.3 天，p=0.004），出院时的功能状态较低（Rankin 评分 3.75±1.57 比 2.29±1.89，p<0.001）。HD-S 患者的死亡率高于 HD-NS 和 NRF-S 患者。
这些患者的中风结果较差，表现为住院时间延长、出院时功能状态较差、对康复的反应非常有限以及死亡率增加。
