International Urology and Nephrology

, Volume 51, Issue 8, pp 1435–1441 | Cite as

Clinical outcomes of stroke in hemodialysis patients: a retrospective single-center study

  • Keren Cohen-HagaiEmail author
  • Naomi Nacasch
  • Ilan Rozenberg
  • Ze’ev Korzets
  • Yael Einbinder
  • Tali Zitman-Gal
  • Sydney Benchetrit
Nephrology - Original Paper



The incidence of stroke in patients undergoing hemodialysis (HD) is eight-to-ten times greater than that of the general population. However, data on the outcome of stroke in these patients are limited.


In this retrospective observational cohort study, electronic medical records of all patients undergoing HD from 1.1.2014 to 31.12.2017 at Meir Medical Center, Israel, were reviewed. Stroke was defined as a focal neurological deficit of cerebrovascular origin, and confirmed as ischemic or hemorrhagic by computed tomography. Age- and sex-matched HD patients who did not experience a stroke (HD-NS) and hospitalized stroke patients with normal kidney function (NRF-S) served as the two control groups. Baseline demographic, clinical, and laboratory data were collected. Thrombolytic therapy, duration of hospital stay, and mortality were recorded. Functional status at discharge was assessed by the Modified Rankin Scale.


In the cohort study group (HD-S), 52 strokes occurred during 248.3 patient years, an incidence rate of 8.13%, and a stroke rate of 0.19% patients/month. Most strokes in HD patients were ischemic, and only four patients were administered tissue plasminogen activator. HD-S had longer hospitalization than did NRF-S (10.6 ± 9.9 vs. 5.96 ± 5.3 days, p = 0.004) and lower functional status at discharge (Rankin score 3.75 ± 1.57 vs. 2.29 ± 1.89, p < 0.001). HD-S patients had a higher mortality than both HD-NS and NRF-S patients.


Stroke outcome in these patients is dismal with prolonged hospital stay, poor functional status at discharge, very limited response to rehabilitation, and increased mortality.


Hemodialysis Stroke Prognosis Outcome 



We thank Faye Schreiber for editing the manuscript and Nava Jelin for statistical analysis.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Herrington W, Haynes R, Staplin N, Emberson J, Baigent C, Landray M (2015) Evidence for the prevention and treatment of stroke in dialysis patients. Semin Dial 28:35–47CrossRefPubMedGoogle Scholar
  2. 2.
    Ovbiagele B, Nguyen-Huynh MN (2011) Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics 8:319–329CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Power A (2013) Stroke in dialysis and chronic kidney disease. Blood Purif 36:179–183CrossRefPubMedGoogle Scholar
  4. 4.
    Murray AM, Seliger S, Lakshminarayan K, Herzog CA, Solid CA (2013) Incidence of stroke before and after dialysis initiation in older patients. J Am Soc Nephrol 24:1166–1173CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mattana J, Effiong C, Gooneratne R, Singhal PC (1998) Outcome of stroke in patients undergoing hemodialysis. Arch Intern Med 158:537–541CrossRefPubMedGoogle Scholar
  6. 6.
    Findlay MD, Thomson PC, Fulton RL, Solbu MD, Jardine AG, Patel RK et al (2015) Risk factors of ischemic stroke and subsequent outcome in patients receiving hemodialysis. Stroke 46:2477–2481CrossRefPubMedGoogle Scholar
  7. 7.
    Alqahtani F, Berzingi CO, Aljohani S, Al Hajji M, Diab A, Alvi M et al (2018) Temporal trends in the outcomes of dialysis patients admitted with acute ischemic stroke. J Am Heart Assoc 7(12):pii:e008686. CrossRefGoogle Scholar
  8. 8.
    Cowen TD, Huang CT, Lebow J, DeVivo MJ, Hawkins LN (1995) Functional outcomes after inpatient rehabilitation of patients with end-stage renal disease. Arch Phys Med Rehabil 76:355–359CrossRefPubMedGoogle Scholar
  9. 9.
    Forrest G, Nagao M, Iqbal A, Kakar R (2005) Inpatient rehabilitation of patients requiring hemodialysis: improving efficiency of care. Arch Phys Med Rehabil 86:1949–1952CrossRefPubMedGoogle Scholar
  10. 10.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607CrossRefPubMedGoogle Scholar
  11. 11.
    Nayak-Rao S, Shenoy MP (2017) Stroke in patients with chronic kidney disease: how do we approach and manage it? Indian J Nephrol 27:167–171CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Poterucha TJ, Goldhaber SZ (2016) Warfarin and vascular calcification. Am J Med 129:635e1–635e4CrossRefGoogle Scholar
  13. 13.
    Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S et al (2009) Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 53:298–309CrossRefPubMedGoogle Scholar
  14. 14.
    McIntyre CW, Goldsmith DJ (2015) Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension? Kidney Int 87:1109–1115CrossRefPubMedGoogle Scholar
  15. 15.
    El Husseini N, Fonarow GC, Smith EE, Ju C, Schwamm LH, Hernandez AF et al (2017) Renal dysfunction is associated with poststroke discharge disposition and in-hospital mortality: findings from get with the guidelines-stroke. Stroke 48:327–334CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Nephrology and HypertensionMeir Medical CenterKfar SabaIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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