Kidney research and clinical practice · 2025
Outcomes of continuous kidney replacement therapy versus intermittent hemodialysis in dialysis-dependent patients with acute intracerebral hemorrhage.
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Watanabe Hideaki, Okada Akira, Shibahashi Keita, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Аннотация
BACKGROUND: This study was performed to investigate whether continuous kidney replacement therapy is more beneficial than intermittent hemodialysis in patients with acute intracerebral hemorrhage undergoing chronic dialysis, while adjusting for more clinically important variables.
METHODS: Dialysis-dependent patients diagnosed with acute intracerebral hemorrhage were identified using the Japanese Diagnosis Procedure Combination database. We compared the in-hospital mortality rates and improvement in modified Rankin Scale scores before intracerebral hemorrhage development to discharge among patients who received continuous kidney replacement therapy or intermittent hemodialysis within 2 days of hospitalization. Overlap weighting based on propensity scores was performed to adjust for potential confounders.
RESULTS: Among 922 eligible patients, 204 received continuous kidney replacement therapy and 718 received intermittent hemodialysis within 2 days of hospitalization. Propensity score overlap weighting analyses showed no significant difference between the continuous kidney replacement therapy and the intermittent hemodialysis groups in terms of in-hospital mortality (45.8% vs. 46.1%; risk difference, -0.3%; 95% confidence interval, -8.8 to 8.2%; p = 0.94) or decline in modified Rankin Scale (-3.1 vs. -3.2; difference 0.1; 95% confidence interval, -0.3 to 0.5; p = 0.64).
CONCLUSION: In this nationwide retrospective cohort study, continuous kidney replacement therapy and intermittent hemodialysis initiated within 2 days of admission showed no significant difference in in-hospital mortality or changes in modified Rankin Scale scores among dialysis-dependent patients with acute intracerebral hemorrhage.
METHODS: Dialysis-dependent patients diagnosed with acute intracerebral hemorrhage were identified using the Japanese Diagnosis Procedure Combination database. We compared the in-hospital mortality rates and improvement in modified Rankin Scale scores before intracerebral hemorrhage development to discharge among patients who received continuous kidney replacement therapy or intermittent hemodialysis within 2 days of hospitalization. Overlap weighting based on propensity scores was performed to adjust for potential confounders.
RESULTS: Among 922 eligible patients, 204 received continuous kidney replacement therapy and 718 received intermittent hemodialysis within 2 days of hospitalization. Propensity score overlap weighting analyses showed no significant difference between the continuous kidney replacement therapy and the intermittent hemodialysis groups in terms of in-hospital mortality (45.8% vs. 46.1%; risk difference, -0.3%; 95% confidence interval, -8.8 to 8.2%; p = 0.94) or decline in modified Rankin Scale (-3.1 vs. -3.2; difference 0.1; 95% confidence interval, -0.3 to 0.5; p = 0.64).
CONCLUSION: In this nationwide retrospective cohort study, continuous kidney replacement therapy and intermittent hemodialysis initiated within 2 days of admission showed no significant difference in in-hospital mortality or changes in modified Rankin Scale scores among dialysis-dependent patients with acute intracerebral hemorrhage.