2023 American Academy of Neurology Abstract Website

Objective:

To investigate the clinical features and outcome of spontaneous intracerebral hemorrhage (ICH) in patients with end stage renal disease (ESRD) on hemodialysis.

Background:

Patients with ESRD on hemodialysis may have labile blood pressure (BP), with elevated BP prior to hemodialysis and hypotension post hemodialysis. The clinical characteristics and outcome of ICH in dialysis patients are not well defined.

Design/Methods:

This is a single center cohort study. All ICH admissions at University of California, Irvine Medical Center from January 1, 2018 to July 31, 2022 were screened. Patients with ESRD on hemodialysis were selected for this study.

Results:

Among 449 ICH admissions during the study period, 27 patients (6.0%) were identified to have ESRD on hemodialysis. The average age of these patients was 51.5±19.1 and 63.0% of them were male. All patients had a history of hypertension and elevated systolic BP at initial presentation (202.8±35.9). 81.5% of patients had a history of diabetes mellitus while 51.9% had dyslipidemia. The most common ICH location was subcortical (40.7%). The average ICH score was 1.56±1.45. Their average ICU and hospital length of stay were 3±1.4 and 9.5±10.6, respectively. The mortality rate at hospital discharge was 22.2%. Multivariate regression analysis showed that mortality rate was independently associated with an ICH score greater than or equal to 3 (OR=34.1, 95% CI 1.45-802.58, p=0.03).

Conclusions:

ICH in patients with ESRD on hemodialysis portends 22.2% mortality rate at hospital discharge. ICH score greater than or equal to 3 was found to be an independent predictor of poor outcome. In order to evaluate the clinical relevance of such findings, further studies comparing these to non-ESRD patients is warranted.