End-stage renal patients 'suffer stroke-related impairments'

By Liam Davenport, medwireNews Reporter

Stroke symptoms are relatively common among patients with end-stage renal disease (ESRD) and are associated with cognitive impairments and reduced ability to perform daily activities, the results of a US study indicate.

"Efforts to increase awareness and screening for stroke symptoms, especially among dialysis providers and patients, would seem warranted in order to reduce stroke-related morbidity and prevent future strokes," say Manjula Tamura, from Stanford University School of Medicine in Palo Alto, California, and colleagues.

In an accompanying editorial in Neurology, Kambiz Kalantari, from the University of Virginia Health System in Charlottesville, and Steven Seliger, from the University of Maryland, suggest: "It might be reasonable for health care providers to assess the presence of stroke symptoms and to have lower thresholds for further workup for those with these symptoms."

They add: "ESRD patients on hemodialysis come into contact with health care providers several times a month, which provides a great opportunity for early detection of these symptoms, potentially reducing morbidity and mortality in this group of patients."

The researchers studied 148 patients with ESRD from five clinics and found that, among 126 patients without a prior stroke or transient ischemic attack, 36.5% reported one or more stroke symptoms. Sudden loss of half the visual field was the most commonly reported symptom, while sudden unilateral weakness was the least commonly reported.

In total, 46.0% of patients met the criteria for cognitive impairment on a neurocognitive battery of tests, while 52.4% were classified as having impaired functional status according to the seven instrumental activities of daily living (IADL).

In a parsimonious model taking into account age, gender, race, education, language, and the presence of diabetes and cardiovascular disease, stroke symptoms were linked to an increased likelihood for cognitive impairment, at an odds ratio of 2.47.

Stroke symptoms in ESRD patients were also associated with a substantial increase in the likelihood for IADL impairment, at an odds ratio of 3.86, after adjusting for the same factors. Neither this nor the association between stroke symptoms and cognitive impairment were affected by the inclusion of additional factors.

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