| [ Summary ] |
Cerebrovascular diseases (CVD) and brain atrophy are one of the major complications reducing the quality of life in dialysis patients. To elucidate the significance of CVD in maintenance dialysis patients, we analyzed its incidence and mortality in 2,123 dialysis patients treated in our hospital from January 1981 to December 1995 retrospectively. The number of patients suffered from cerebral infarction and cerebral hemorrhage were 125 and 55. Among these patients, 13 cases out of 125 cerebral infarction and 27 cases out of 55 cerebral hemorrhage died. The mortality of cerebral hemorrhage in dialysis patients, however, decreased recently probably due to amelioration of hypertension before and after the initiation of dialysis therapy, and improvement of dialysis therapy. In case of cerebral hemorrhage, the hemodialysis (HD) without heparinization rather than peritoneal dialysis can be recommended because HD can strictly control blood pressure, volume status and brain edema. To evaluate the degree of brain atrophy (cerebral ventricular dilatation and white matter atrophy) in maintenance dialysis patients, we calculated bicaudate cerebroventricular index by CT in 62 dialysis patients, 25 essential hypertensives and 33 normal controls. Brain atrophy was often found especially in elderly dialysis patients, furthermore, this lesion occurred 20 years earlier than normal controls, and 10 years earlier than essential hypertensives. White matter degeneration (Binswanger's disease ; sub cortical arteriosclerotic encephalopathy) and a symptomatic cerebral infarction were frequently found by CT or MRI in dialysis patients, especially in diabetic nephropathy and hypertensive nephrosclerosis cases. Etiology of CVD, brain atrophy and white matter degeneration observed in dialysis patients is obscure, but it may be suggested that the arteriosclerotic factors including original disease of renal failure, complicated hypertension, uremia and dialysis therapy itself are responsible for this brain lesion. |