Mattana J, Effiong C, Gooneratne R, Singhal P C
Division of Nephrology, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
Arch Intern Med. 1998 Mar 9;158(5):537-41. doi: 10.1001/archinte.158.5.537.
While elevated levels of serum creatinine have been shown to be a risk factor for diminished survival after stroke, it is unknown how renal replacement therapy may affect the outcome.
Strokes occurring in 26 consecutive patients undergoing hemodialysis at our institution were reviewed and clinical and laboratory variables and outcome were compared with those of patients who had a stroke but had normal renal function.
Twenty-four strokes in the patients undergoing hemodialysis were ischemic while only 2 were hemorrhagic. Virtually all the patients had hypertension, half had diabetes mellitus, and most had some prior evidence of cardiovascular disease at the time of their stroke. Fifty percent of the patients undergoing hemodialysis had a good outcome (defined as being discharged home) while the remainder had a poor outcome (defined as dying or being discharged to a nursing facility). The combined presence of hypertension and coronary artery disease had a sensitivity of 91.2% for identifying patients with a poor outcome, while male sex, the presence of coronary artery disease, and the combined presence of hypertension, coronary artery disease, and/or congestive heart failure had sensitivities greater than 80% but low specificity. The outcome of patients undergoing hemodialysis was comparable with that of a control group of patients who had a stroke but had normal renal function, although the length of hospital stay was greater (mean [+/-SEM] 29.8+/-6.4 days vs 12.7+/-1.1 days, respectively; P<.01).
Hospitalized patients undergoing hemodialysis in whom stroke occurs appear to have as good an outcome as that of patients with normal renal function, although they are hospitalized longer. In addition, certain clinical variables seem to be associated with a worse outcome. Aggressive measures to prevent and treat stroke seem as warranted for patients undergoing hemodialysis as for patients with normal renal function, although interventions to reduce the length of hospital stay are needed.
虽然血清肌酐水平升高已被证明是中风后生存率降低的一个危险因素，但肾脏替代治疗如何影响预后尚不清楚。
回顾了在我们机构接受血液透析的26例连续发生中风的患者，并将临床和实验室变量及预后与中风但肾功能正常的患者进行比较。
接受血液透析的患者中有24例中风为缺血性，只有2例为出血性。几乎所有患者都患有高血压，一半患有糖尿病，大多数在中风时已有心血管疾病的某些先前证据。接受血液透析的患者中有50%预后良好（定义为出院回家），其余预后不良（定义为死亡或出院到护理机构）。高血压和冠状动脉疾病同时存在对识别预后不良患者的敏感性为91.2%，而男性、冠状动脉疾病的存在以及高血压、冠状动脉疾病和/或充血性心力衰竭同时存在的敏感性大于80%但特异性较低。接受血液透析的患者的预后与中风但肾功能正常的对照组患者相当，尽管住院时间更长（分别为平均[±标准误]29.8±6.4天和12.7±1.1天；P<0.01）。
中风的接受血液透析的住院患者似乎与肾功能正常的患者有同样好的预后，尽管他们住院时间更长。此外，某些临床变量似乎与较差的预后相关。对于接受血液透析的患者，积极预防和治疗中风的措施似乎与肾功能正常的患者一样有必要，尽管需要采取干预措施来缩短住院时间。
