| [ Summary ] |
Dialysis patients due to diabetic nephropathy are at high risk for incident cerebrovascular diseases. They experience higher mortality rates than other dialysis patients in Japan. Diabetic dialysis patients are predisposed to experience ischemic strokes of hemodynamic origin because they are prone to suffer from hypotension during hemodialysis or tilting after hemodialysis. Optimal settings, including dry weight and limitation of ultrafiltration rates during hemodialysis should be kept in mind in order to prevent hemodialysis-associated hypotension and subsequent strokes. In other words, it is important to educate patients to reduce their interdialytic weight gain. In dialysis patients, the prevalence of atrial fibrillation is extremely high. However, an association with stroke involvement still remains unclear and the preventive effects of anticoagulant agents on brain infarction are also unclear. Many practitioners who treat stroke victims think thrombolytic therapy can be applicable to dialysis patients. Therefore, it is recommended that dialysis physicians should establish systems to transport those patients to specialized hospitals. Shortly after onset, dialysis methods which cause only mild increases in intracranial pressure should be selected. |