| Theme |
New perspectives in the management of patients with diabetes undergoing dialysis |
| Title |
Cerebrovascular diseases in diabetic patients undergoing dialysis |
| Author |
Hiroto Hiyamuta |
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Kazuhiko Tsuruya |
Department of Nephrology, Nara Medical University |
| [ Summary ] |
Diabetes mellitus and chronic kidney disease are both independent risk factors for ischemic and hemorrhagic stroke. Therefore, diabetic patients undergoing dialysis are at a significantly higher risk of cerebrovascular diseases. The risk of hemodynamic ischemic stroke in diabetic patients undergoing dialysis is significantly higher than that in non-diabetic patients undergoing dialysis. This heightened risk is attributable to severe orthostatic hypotension and reduced cerebral blood flow and oxygen delivery in the former group. Thus, in addition to treatment for hyperglycemia, hypertension, and anemia, the prevention of orthostatic hypotension immediately after hemodialysis is important to prevent stroke in these patients. The use of anticoagulants in patients with atrial fibrillation undergoing hemodialysis remains controversial, because several studies have shown an increased risk of hemorrhagic events in such patients, and the anti-thrombotic effects of these agents are unclear. Further studies are required to prove the propriety of this therapy in these patients. |