Stroke in Hemodialysis Patients and Mortality

: Introduction: End Stage Renal Disease ESRD is associated with an increases risk of cerebrovascular accidents with significant morbidity and mortality. Stroke is the third most common cause of cardiovascular disease death in hemodialysis patients. Chronic renal disease is an independent risk factor for stroke in the general population. The American Heart Association and American Stroke Association have redefined a stroke as brain spinal or retinal cell death attributable taischemia, based on pathological, imaging, other objective evidence, and /or clinical evidence. Furthermore the new definition include the concept of “silent infarction/ hemorrhage ”to take into account. Lesions were discovered on neuroimaging on neuro-pathological examination without a history of acute neurological dysfunction attributed to the lesion. Objective: To highlight the risk factors for stroke in our dialysis population, to see the prevalence of stroke in this population, and evident mortality rate among dialysis patient with stroke. Methods: We conducted a retrospective, qualitative and descriptive study which involved 1732 patients from 5 different centers in the Amerikan Hospital starting November 2008 to December 2019. We evidenced 70 different case of cerebrovascular accidents. Also we took a control group of 70 dialysis patients to compare, ( those we did not select it preferentially but we selected according to the ordinal registrations in to the centers) Results: A total number of 1732 patients were observed during November 2008 till December 2019. Of these 70 patients were diagnosed with cerebrovascular accidents. The mean age was 57.6 years. 33patients were females (47%) and 37 patients were males (53%). 23 patients were younger than 55 years old and 47 patients (68%) were older than 55 years. The mean age of the control group is 53.69 years. The vascular access in 22 patients was AVF (fistula 30.4 %) and 48 had a central venous catheter (69.6%). In the control group there were 52 AVF(74.3%), 1 GAV, and 17 CVC (24.3%). The average hemoglobin levels in the stroke group were 9.3 g/dl compared to 11.4 g/dl of the control group. Between the hemorrhagic group, 18 patients (25.7%) in total, mortality was 94.44%, only one patient survived. There were 52 patients with ischemic stroke (74.28%) and the mortality was 40.3% (21 patients). In the control group 14 patients died during the study (20%) and 2 patients had renal transplantation. Conclusions: The prevalence of stroke among hemodialysis patients in our center resulted 4.01%. The patients with stroke tended to be older, with lower hemoglobin values and thecentral venous catheter represented the vascular access in the majority of the patients (69.6%). Vascular access may increase stroke risk by affecting cerebral hemodynamics. Mortality was very high in patients with hemorrhagic stroke. Different factors were present. a cerebrovascular event versus those who did not, suggesting that these aspects may not be correctly identified in dialysis patients (5). Measurement of cardiac function by echo-cardiographi, chest radiography and physical examination is suggested for all patients before initiating hemodialysis therapy.