Silent cerebral infarction in hemodialysis patients: possible predictors for vascular events

ABSTRACT

We designed this study on hemodialysis [HD] patients to estimate the prevalence of silent brain infarction [SBI]; to evaluate the cardiovascular risk factors for SCI; and to investigate whether or not SCI is associated with clinical vascular events. Fifty HD patients who had no past history of stroke or TIA were included in this prospective study. We followed these patients for two years to record any vascular events related to cardiovascular or cerebrovacsular diseases. All patients underwent CT or MRI on the brain to define any silent brain infarcts. We investigated the prognostic role of SCI in cerebral, cardiac and vascular events by using Cox proportional hazards analysis. SCI was detected in 16 patients out of 50 HD patients with a percentage of 32%. During follow up period, vascular events were detected in ten patients after two years of follow up; six cerebral events; three cardiac events; and one death. The HD patients group with SCI had none significantly higher cerebral and cardiac morbidity than the group without SCI. Patients with SCI were significantly older than those without SCI and had significantly longer duration of HD. Furthermore, HD patients with SCI had significantly higher systolic and diastolic blood pressure than those without SCI. We could not find a difference between HD patients with SCI and those without SCI as regards other cardiovascular risk factor except for ischemic heart disease [IHD]. Using univariate analysis, we found that age, duration of HD, IHD and silent brain infarction were predictors of vascular events, whereas, duration of HD and SCI were predictors of cerebral events. By multivariate analysis, we found that SCI was a powerful independent predictor of cerebral and vascular events. We concluded that the presence of SCI is an independent risk factor for vascular events in HD patients