SP623RISK FACTORS OF CEREBROVASCULAR EVENTS IN HEMODIALYSIS PATIENTS. PROSPECTIVE CASE CONTROL STUDY

Abstract

INTRODUCTION AND AIMS: Chronic renal failure patients have an increased prevalence of cerebrovascular diseases. Dialysis patients have severe vascular diseases burden because of the co-morbid conditions such as diabetes, hypertension, hyperlipidemia. Our aim is to evaluate the results of patients who underwent brain imaging for any reason ( imbalance, dizziness, numbness, paralysis) and to examine factors predicting or affecting cerebrovascular events (CE) in hemodialysis patients. METHODS: 432 patients who underwent hemodialysis at our center for at least 5 months were included in the study. Patients characteristics, etiology of renal failure, comorbid conditions and the average of last 5 months laboratory results were recorded. After 3 years of observation, 264 patients had serebral CT or MRimaging. Cerebrovascular pathology was detected in 139 patients. RESULTS: Of those 139 patients; 65 (15 %) patients have ischemic lesion, 25 (5,8%) patients hemorragic lesion, 49 (%11.3) patients had small vessel ischemia. The first recorded data and subsequent clinical findings of patients who had CE and had not CE were compared. There were no difference in terms of the gender. The cause of end stage renal disease were diabetes in 58,5% of patients who had ischemic lesion, 52% in patients with hemorragic lesion and 55% in patients with small vessel ischemia (p: <0,05). Firstly, patients with cerebrovascular ischemia and with normal cerebrovascular imaging were compared. Patients with cerebrovascular ischemia were older [63 [23-86] years vs; 54 (17-83) years p:0,0001], serum creatinin [8,0662,65 mg/dl vs 9,0962,42 mg/dl, p:0,0001 ] were lower, and C-reactive protein [9 (2-68) mg/L vs 4,8( 1-103) mg/L, p: 0,002 ] were higher than normal patients. Than we compared patients with cerebrovascular hemorrhage and with normal cerebrovascular imaging. Hemorrhagic patients were older [64 [22-88] years vs; 54 (17-83) years, p:0,003], serum creatinin [7,3662,52 mg/dl vs 9,0962,42 mg/dl, p:0,003 ], predialysis serum potassium levels[ 3,3360,43 mEq/L vs 3,560,32 mEq/L, p:0,003] and parathyroid hormon [ 174 (10-1212) vs 427 (1-3145) pq/ml, p:0,004 ] were lower than others. Finally, we compared patients with cerebrovascular small vessel ischemia and with normal cerebrovascular imaging. Patients with cerebrovascular small vessel ischemi were older [65 (41-86) years vs; 54 (17-83) years, p:0,0001], serum creatinin [8,5167,06 mg/dl vs 9,0962,42 mg/dl, p:0,0001 ], serum phosphorus levels[ 4,361,57 mg/dl vs 5,0061,36 mEq/L, p:0,007] and parathyroid hormon [ 296 (4-1287) pq/ml vs 427 (1-3145) pq/ml, p:0,013 ] were lower, C-reactive protein [8 (2-208) mg/L vs 4,8( 1-103) mg/L, p:0,002 ] were higher than normal patients. Neither Kt/V, nor serum lipid levels were associated with CE. CONCLUSIONS: Older age, lower serum creatinin, and diabetes were significantly predictive in all subtypes of CE.