Stroke in dialysis patients

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Abstract

Cerebrovascular disorders are the most frequent and urgent complications of chronic kidney disease, especially, in the dialysis period.

The purpose is to provide an analytical review of current (2011 and later) publications containing a comprehensive analysis of stroke data in dialysis patients.

Methods. A critical analysis of the literature data with a generalization of the currently available results of the original studies on the stroke in dialysis patients.

Results. The risk of stroke increases many times in hemodialysis patients with end-stage chronic kidney disease. According to different publications, the risk of hemorrhagic stroke increases 4–6 times, and ischemic stroke — 2–3 times, compared with the general population. Dialysis patients are under the higher risk of mortality after the stroke. The presence of atrial fibrillation in a dialysis patient is prognostically unfavorable and increases the frequency of stroke by 2.5 times, mortality by 2 times, compared to dialysis patients without atrial fibrillation.

Conclusions. There is lack of studies on the use of warfarin in comparison with aspirin or new oral anticoagulants to conclude on the benefits of one or another way of management in dialysis patients with atrial fibrillation. Apparently, the use of warfarin is not justified in dialysis patients. Thrombolytic therapy is not indicated to a dialysis patient with acute period of ischemic stroke. The use of prolonged renal replacement therapy is preferable in the patients with acute stroke and acute renal failure. It is suggested to carry out hemodialysis without anticoagulation or (if necessary) with the use of fractionated heparins in case of increased risks of bleeding.

About the authors

Aleksej E. Khrulev

Privolzhsky Research Medical University

Author for correspondence.
Email: alexey_khrulev@mail.ru
ORCID iD: 0000-0003-0169-3956
SPIN-code: 1051-9769
Scopus Author ID: 57210284114
ResearcherId: AAA-6833-2019
http://employee.pimunn.ru/id766/details

Ph. D., Associated Professor, Department of Neurology, Neurosurgery and Medical Genetics

Russian Federation, 603950, N. Novgorod, Minin and Pozharsky Square, 10/1

Elena A. Monashova

Privolzhsky Research Medical University

Email: alexey_khrulev@mail.ru

кафедра неврологии, нейрохирургии и медицинской генетики

Russian Federation, 603950, N. Novgorod, Minin and Pozharsky Square, 10/1

Nadezhda A. Shestakova

Privolzhsky Research Medical University

Email: alexey_khrulev@mail.ru

кафедра неврологии, нейрохирургии и медицинской генетики

Russian Federation, 603950, N. Novgorod, Minin and Pozharsky Square, 10/1

Yulia A. Paramonova

City clinical hospital №10

Email: alexey_khrulev@mail.ru

 доцент

Russian Federation, 603011, N. Novgorod, Chongarskaya Str., 43

Vera N. Grigorieva

Privolzhsky Research Medical University

Email: alexey_khrulev@mail.ru

доктор медицинских наук, профессор, зав.кафедрой неврологии, нейрохирургии и медицинской генетики

Russian Federation, 603950, N. Novgorod, Minin and Pozharsky Square, 10/1

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Supplementary files

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2. Fig. 1. The pathogenesis of the occurrence of cerebrovascular disorders in patients with dialysis period of the terminal stage of chronic kidney disease (CKD); KN - cognitive impairment; FR - risk factors

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3. Fig. 2. The total risk of stroke in patients undergoing hemodialysis and peritoneal dialysis (adapted from: Fu et al., 2015)

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Copyright (c) 2020 Khrulev A.E., Monashova E.A., Shestakova N.A., Paramonova Y.A., Grigorieva V.N.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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