Analysis of risk factors for cerebral hemorrhage in maintenance hemodialysis patients with end-stage renal disease

He Juxiang

Duan Dongmei

Sha Ying

Wang Ancai

Department of Nephrology,Tongling People's Hospital

Abstract:Objective To explore the risk factors for cerebral hemorrhage during maintenance hemodialysis(MHD)treatment in patients with end-stage renal disease(ESRD). Methods Thirty-two patients with ESRD who underwent MHD treatment and developed cerebral hemorrhage in the Department of Nephrology of Tongling People' s Hospital from January2021 to December 2024 were selected as the cerebral hemorrhage group, and 116 MHD patients hospitalized without cerebral hemorrhage during the same period were included in the control group. Multivariate logistic regression was used to analyze the influencing factors for cerebral hemorrhage during MHD treatment in ESRD patients. Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive efficacy of independent risk factors for cerebral hemorrhage during MHD treatment in ESRD patients. Results The total mortality rate of 32 patients in the cerebral hemorrhage group after treatment was 53.1%(17/32). Compared with the control group, the cerebral hemorrhage group had a longer course of uremia and dialysis duration, a higher proportion of hypertension and diabetes, and higher levels of uric acid, triglycerides, and pre-dialysis blood sodium. The levels of serum albumin, hemoglobin, and platelet count were lower(χ2/t = 10.137, 6.370, 3.040, 2.811,5.469, 3.592, 2.988, 4.756, 3.790, 5.469, all P<0.001). Hypertension, high uric acid, and high pre-dialysis blood sodium were independent risk factors for cerebral hemorrhage during MHD treatment in ESRD patients[OR(95%CI) = 6.600(1.306-33.350), 1.007(1.002-1.012), 1.084(1.004-1.169)]. High serum albumin and high platelet count were independent protective factor[OR(95%CI) = 0.828(0.738-0.929), 0.975(0.958-0.992)]. The AUC values of hypertension, uric acid, and pre-dialysis sodium alone and in combination for predicting cerebral hemorrhage during MHD treatment in ESRD patients were 0.653,0.816, 0.708, and 0.923, respectively. The combination of the three was superior to each individual predictor(Z = 6.932, 2.855,3.404, all P<0.001). Conclusion The combination of hypertension, uric acid, and pre-dialysis sodium can effectively predict the risk of cerebral hemorrhage in ESRD patients undergoing MHD treatment. Early intervention for ESRD patients with hypertension, low serum albumin, low platelet count, high uric acid, and high pre-dialysis sodium is of great significance for the prevention and treatment of cerebral hemorrhage.

Keyword:End-stage renal diseaseMaintenance hemodialysisCerebral hemorrhageRisk factors

Fund:Research Project of the Health Commission of Anhui Province (AHWJ2023BAc20076)

Authors:*王安才，E-mail:yjswac@sina.com;