Incidence of Stroke in Hemodialysis Patients with Central Venous Catheter: A Systematic Review

Background and Aim: End Sage Renal Disease (ESRD) patients require hemodialysis (HD) as a common treatment. HD needs a vascular access (VA) and Central venous catheter (CVC) placement is a highly used VA for those patients that do not have a matured arteriovenous fistula (AVF). Unfortunately, the risk of stroke in patients with ESRD is ۵–۳۰ times greater than that in the general population and our recent studies show risk of ischemic stroke in patients with chronic kidney disease (CKD): Specially, Stroke is one of significant complication after CVC placement and therefore, it is important to understand the factors that cause stroke in this vulnerable population. Materials and Methods: Our study reviews the research had analyzed a significant population of HD patients, focusing on the prevalence of stroke after the CVC, and have been published in the last two decades )۲۰۰۰-۲۰). We used data mining methods for extracting novel and useful patterns from the inputted data, based on CRISP (CRoss Industry Standard Process for Data Mining) Process: Results: Previous studies have resulted a different rates of stroke in HD patients. Whereas a ۲۰۱۴ study in Taiwan on ۷۴,۰۰۰ HD patients has reported “older age as an independent risk factor for both types of stroke” and the incidence of hospitalization for ischemic stroke and for hemorrhagic stroke in HD patients [per ۱۰,۰۰۰ person-years] have been ۱۰۲.۶ and ۴۲.۴, respectively. Moreover, another ۲۰۱۹ study on ۳۷,۶۲۳ HD patients in the same country, who have received CVC placement over ۲۰۰۰–۱۰ and propensity score-matched individuals without CVC placement as the comparison cohort, has been resulted “compared with the comparison group, CVC placement increased the average annual ischemic stroke incidence [۱۹.۵ vs. ۱۱.۶ per ۱۰,۰۰۰ person-years]” but emphasizes that “CVC placement increases ischemic stroke risk, particularly in those aged ۳۵ ≤ years”. Despite the resulted characteristics present increasing Stroke after CVC insertion, some studies focus on aged HD patients, meanwhile another part of the studies suggest, CVC placement increases ischemic stroke risk, particularly in young HD patients; And hence, these trends warrant further investigation about impact of patients' age. But more literature review specifies that “CVC placement”, “hypertension” and “diabetes mellitus” are stroke risk factors, respectively: Conclusion: The obtained results reaffirm that stroke is a CVC-related complication in HD patients, while according to our previous studies, AVF has much less complications, and so present study concludes: “For stroke prevention, preferably, the AVF is recommended over the CVC placement for HD patients who may not be eligible to receive a kidney transplant”.

Keywords:

Arteriovenous fistula , Central venous catheter , Hemodialysisو Stroke , Vascular access