Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai 200072, China.
J Stroke Cerebrovasc Dis. 2021 May;30(5):105686. doi: 10.1016/j.jstrokecerebrovasdis.2021.105686. Epub 2021 Mar 15.
End-stage renal disease (ESRD) is one of the most critical risk factors of intracerebral hemorrhage (ICH). We aimed to investigate the effects of maintenance hemodialysis on hematoma volume, edema volume, and prognosis in patients with comorbid ESRD and ICH.
Patients with comorbid ESRD and ICH were divided into two groups based on whether receiving maintenance hemodialysis. Hematoma and perihemorrhagic edema (PHE) volumes and relative edema ratio after admission were assessed on head computed tomography scans.
During the initial diagnosis, the dialysis group had lower PHE volume (16.41 vs 35.90 mL, P = 0.010), total volume of hematoma and edema (31.58 vs 54.58 mL, P = 0.013), and relative edema ratio (0.57 vs 0.92, P = 0.033) than the non-dialysis group. In addition, the peak PHE volume (36.68 vs 84.30 mL, P < 0.001), peak total volume of hematoma and edema (53.45 vs 127.69 mL, P = 0.011), and peak relative edema ratio (1.12 vs 1.92, P = 0.001) within one week after onset were lower in the dialysis group than in the non-dialysis group. The dialysis group had a higher in-hospital mortality rate than the non-dialysis group (40% vs 10%, P = 0.007). At 1-year follow-up, the two groups had similar 1-year-mortality rates and modified Rankin Scale.
Hemodialysis can prevent the enlargement of edema and reduce PHE volume shortly after onset. Although dialyzed patients had a higher in-hospital mortality rate, hemodialysis did not affect 1-year survival rate and functional neurologic scales.
终末期肾病（ESRD）是脑出血（ICH）的最重要的危险因素之一。本研究旨在探讨维持性血液透析对合并 ESRD 和 ICH 患者血肿体积、水肿体积和预后的影响。
根据是否接受维持性血液透析，将合并 ESRD 和 ICH 的患者分为两组。入院时通过头部 CT 评估血肿和血肿周围水肿（PHE）体积以及相对水肿比。
在初诊时，透析组 PHE 体积（16.41 比 35.90 mL，P = 0.010）、血肿和水肿总体积（31.58 比 54.58 mL，P = 0.013）和相对水肿比（0.57 比 0.92，P = 0.033）均低于非透析组。此外，透析组的 PHE 峰值体积（36.68 比 84.30 mL，P < 0.001）、血肿和水肿总体积峰值（53.45 比 127.69 mL，P = 0.011）和相对水肿比峰值（1.12 比 1.92，P = 0.001）在发病后一周内均低于非透析组。透析组的住院死亡率高于非透析组（40%比 10%，P = 0.007）。在 1 年随访时，两组的 1 年死亡率和改良 Rankin 量表评分相似。
血液透析可在发病后不久阻止水肿扩大并降低 PHE 体积。尽管透析患者的住院死亡率较高，但血液透析并不影响 1 年生存率和神经功能量表。
