Hemorrhagic Stroke in Chronic Dialysis Patients

The incidence of hemorrhagic stroke was higher than the incidence of ischemic stroke in chronic dialysis patients. The mortality of hemorrhagic stroke was high and most patients died rapidly after the onset of cerebral hemorrhage (GH). The optimal modality of dialysis after CH is still controversial but there was a preference for slow continuous dialysis, like peritoneal dialysis (PD). We retrospectively studied the chronic dialysis patients who were admitted to NTUH with the diagnosis of acute hemorrhagic stroke from January 1991 to June 1999. There were totally 16 patients analyzed, 10 males and 6 females. The average age was 59.4±13.3 year-old. Before admission, 14 patients had chronic hemodialytsis (HD) and two patients had PD. The comorbidity included hypertension (16/16), DM (9/16), previous cerebrovascular accidents (9/16) and hyperlipidemia (5/16). The location of CH included putamen (6/16), brain stem (3/16), thalamus (3/16), massive (2/16), and others (2/16). Among the 14 patients who were under chronic HD before CH, 8 patients continued to have HD and 6 patients switched to PD. The two patients who were under PD Other alterations of dialysis included change of dialysis frequency, duration, anticoagulation strategy and blood flow. The overall mortality was 44% (7/16). One of the 8patients who continued HD died (mortality 12.5%). 6 of the 8 patients who had PD after the event died (mortality 75%). Two patients underwent surgical intervention and both died. The major cause of death was neurological deterioration. One patient died of pneumocephalus. The interval between the onset of CH and death was short (15 ±13 days, 2-39 days). There was a tendency toward older age, longer duration of dialysis, PD, lower hemoglobin level and worse neurological status at the onset of CH in the non-survived group.

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