Ischemic cerebrovascular diseases in chronic renal failure

• Published in: Japanese Journal of Stroke Vol. 19; no. 1; pp. 71 - 78
• Main Authors: Ebisawa, Toshihiro, Toyohara, Keizou, Sakai, Osamu, Shimojo, Sadatomo, Honda, Hidehiko
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 1997
• Subjects: cerebral infarction; chronic renal failure; dialysis; erythropoetin; hematocrit
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.19.71

The clinical characteristics of ischemic cerebrovascular disease as a complication of chronic renal failure (CRF) were investigated. The materials consisted of 645 cases of CRF admitted to our service, among which 49 cases of cerebral infarct (CI) were found (7.6%). These cases were subdivided into three groups : (1) 15 out of 293 hemodialysis patients (5.1%) [HD], (2) 7 out of 148 patients on peritoneal dialysis (4.7%) [PD], and (3) 27 out of 204 patients on conservative therapy (13.2%) [non-D]. As regards the underlying diseases, diabetic nephropathy ranked second after chronic glomerulonephritis. In the HD group, the incidence of hemiparesis was significantly lower as an initial symptom. On cranial CT and MRI examination, a higher incidence of lacunar infarct was noted. Concerning complications, the incidences of ischemic heart disease and diabetes mellitus were significantly high. An analysis of the respective parameters revealed that the hematocrit value was significantly lower in the HD group. CI as a complication of CRF was observed at a higher incidence in the non-D group, and especially in those with risk factors of diabetes mellitus, ischemic heart diseases, advanced age (i.e. elderly) and hypertension. It is worthy of note that main truncal artery occlusion as a cause of direct death was rather rare in CI of CRF. The fact that there was a higher incidence of lacunar infarct, especially in the HD group, suggests a possible relation to a lower hematocrit value and complication with diabetes. Further studies are needed to clarify the relationship between use of erythropoetin and hematocrit value in the etiology of ischemic cerebrovascular diseases.