Risk Factors Of Cerebrovascular Events In Maintenance Hemodialysis Patients

Objective:End-stage kidney disease(CKD)is the final result of all chronic kidney disease,its incidence is rising trend year by year,maintenance hemodialysis(maintenance hemodialysis,MHD)is the common treatment methods.However,there are still problems of high complications and mortality in dialysis patients.Cardiovascular and cerebrovascular diseases,especially cerebrovascular events,account for the second cause of death in all dialysis patients.Therefore,it is of great significance to analyze the risk factors of cerebrovascular events in MHD patients.However,currently,the number of relevant studies is limited with a small sample size,and most of them are single-factor studies.Therefore,this study intends to conduct a comprehensive study on the risk factors of cerebrovascular events in MHD patients.Methods: The clinical data of 192 patients with maintenance hemodialysis in the hemodialysis center of Chengdu Fifth People’s Hospital from January 2016 to January 2018 were collected for retrospective analysis.And according to whether it is complicated with cerebrovascular disease,it can be divided into two groups,the concurrent group and the non concurrent group.Baseline clinical data such as gender,age,smoking,primary disease,dialysis age,blood pressure and laboratory examination data Hb,TG,LDL-C,UA,CA,P,ALB,PTH,PPI,BMI,WC,FPG,24 hpg,FT4,TSH,kt / V were collected and analyzed.;the occurrence and death of cerebrovascular events were recorded,and the risk factors of cerebrovascular events were found.Results : 192 patients were included in this study which 98 were male and 94 were female.There were 103 cases of urban population and 89 cases of rural population.The subjects included in the study ranged from 28 to 79 years old,with an average age of 49.25±12.45 years old.Most of them were aged 50-59 years old.In this group,the majority of the respondents were primary school,middle school and high school students,and the majority were workers and farmers.The average per capita annual income is 10,000 to 100,000 yuan.The prevalence of diabetes and hypertension in this group was 36.98% and 43.75%,respectively.The proportion of patients with abnormal lipid metabolism,overweight,obesity and Hb was 16.67%,17.70% and 31.25%,respectively.Among the 192 patients included in the study,Nanalysis the basic data and inspection results,patients were divided into the complication group and the non-complication group based on whether there was cerebrovascular accident or not,among which 66 patients were in the complication group,accounting for 34.38% of the total.According to the baseline statistics,this study also found that 57.57%,81.81%,36.36%,24.24%,71.21% and 56.06% of the total complications were caused by diabetes,hypertension,overweight / obesity,abnormal lipid metabolism,Hb and smoking,respectively.Among the 66 patients with complications,there were 20 cases of cerebral hemorrhage,14 cases of cerebral infarction,5 cases of white matter thinning and 27 cases of cervical vascular plaques,accounting for 30.30%,21.21%,7.57% and 40.91% of the total complication population,respectively.The results of single factor analysis showed that there were differences in dialysis age,blood pressure,pulse pressure,Hb,TG,LDL-C,ALB,UA,blood phosphorus,calcium phosphorus product,PTH,kt / V,PPI between the two groups,but there were no differences in age,gender,BMI,WC,FPG,24 hpg,HDL-C,FT4,TSH and smoking cases(P >0.05).Multivariate Logistic regression analysis showed that the risk factors of cardiovascular and cerebrovascular diseases in MHD patients were long dialysis age,low ALB,high UA,hypertension,high phosphorus,high calcium phosphorus product,high PTH,low kt / V,high PPI and high Hb are the risk factors of cerebrovascular events in MHD patients(P < 0.05).Conclusion:1.In MHD patients,the incidence of cerebrovascular complications is high,which is manifested in the most sclerotic plaques in the neck,followed by cerebral hemorrhage and cerebral infarction,and finally the sparse white matter in the brain.2.The proportion of diabetes,hypertension,overweight / obesity and smoking in MHD group was significantly higher than that in the control group.3.There were significant differences in the age of dialysis,ALB,UA,SBP,DBP,TG,LDL-C,blood phosphorus,calcium phosphorus product,Kt / V,PPI,Hb,PTH between the MHD group and the control group.4.Multiple regression analysis indicated that the risk factors of cerebrovascular complications in MHD patients were long dialysis age,hypertension,low ALB,hyperuricemia,high phosphorus,high calcium phosphorus product,low Kt / V,high PPI,high Hb and high PTH.