Lower serum calcium and pre-onset blood pressure elevation in cerebral hemorrhage patients undergoing hemodialysis

  • Mineaki KitamuraEmail author
  • Yohei Tateishi
  • Shuntaro Sato
  • Yuki Ota
  • Kumiko Muta
  • Tadashi Uramatsu
  • Tsuyoshi Izumo
  • Yasushi Mochizuki
  • Takashi Harada
  • Satoshi Funakoshi
  • Takayuki Matsuo
  • Akira Tsujino
  • Hideki Sakai
  • Hiroshi Mukae
  • Tomoya Nishino
Original article



Asymptomatic blood pressure (BP) elevation may be associated with cerebral hemorrhage (CH); however, few studies have investigated this association. We aimed to evaluate BP elevation before CH in hemodialysis (HD) patients and elucidate its associated factors.


We reviewed HD patients treated for CH at our hospital between 2008 and 2019 (CH group). The control group comprised HD patients treated at Nagasaki Renal Center between 2011 and 2012. Data were obtained from medical records and three consecutive HD charts, made immediately before CH. HD1 was the session closest to onset, followed by HD2 and HD3. Systolic and mean BP were evaluated at the beginning of HD, and factors associated with BP elevation were investigated.


The CH and control groups included 105 and 339 patients, respectively. Systolic and mean BP at HD1 were significantly higher than those at baseline (HD2 + HD3) in the CH group by 5 and 3 mmHg, respectively (P < 0.001). Multiple linear regression analysis showed that lower calcium levels were significantly associated with BP elevation in the CH group (P < 0.05). The CH group was sub-divided by June 2013; the latter group had lower calcium levels (9.2 mg/dL) and a marked systolic BP difference from baseline (+ 10 mmHg) compared with the former (9.5 mg/dL and − 4 mmHg).


Asymptomatic BP elevation was observed in HD patients before CH; this elevation was associated with lower serum calcium levels and observed more frequently in the recent era. The precise mechanism underlying this effect remains unknown.


Cerebral hemorrhage Hemodialysis Blood pressure elevation Serum calcium 



We would like to express special thanks to Tomoko Kawaguchi and Koji Ide for creating the databases. This study was supported by a Grant-in-Aid for Scientific Research (KAKENHI; Grant number 19K17747)

Compliance with ethical standards

Conflict of interest

All the authors have declared no competing interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (Nagasaki University Hospital IRB approval number 1602221-3, Nagasaki Renal Center IRB approval number 30001) and with those of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Although participants in this study were informed, the study was a retrospective survey and the data of participants were anonymized. Consequently, the IRBs approved the waiver of written informed consent from patients.

Supplementary material

10157_2020_1846_MOESM1_ESM.docx (13 kb)
Supplementary file1 (DOCX 12 kb)
10157_2020_1846_MOESM2_ESM.docx (14 kb)
Supplementary file2 (DOCX 13 kb)
10157_2020_1846_MOESM3_ESM.docx (17 kb)
Supplementary file3 (DOCX 16 kb)


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Copyright information

© Japanese Society of Nephrology 2020

Authors and Affiliations

  • Mineaki Kitamura
    • 1
    • 2
    Email author
  • Yohei Tateishi
    • 3
  • Shuntaro Sato
    • 4
  • Yuki Ota
    • 2
  • Kumiko Muta
    • 2
  • Tadashi Uramatsu
    • 2
  • Tsuyoshi Izumo
    • 5
  • Yasushi Mochizuki
    • 1
    • 6
  • Takashi Harada
    • 8
  • Satoshi Funakoshi
    • 8
  • Takayuki Matsuo
    • 5
  • Akira Tsujino
    • 3
  • Hideki Sakai
    • 6
  • Hiroshi Mukae
    • 7
  • Tomoya Nishino
    • 2
  1. 1.Division of Blood PurificationNagasaki University HospitalNagasakiJapan
  2. 2.Department of NephrologyNagasaki University HospitalNagasakiJapan
  3. 3.Department of Neurology and StrokologyNagasaki University HospitalNagasakiJapan
  4. 4.Clinical Research CenterNagasaki University HospitalNagasakiJapan
  5. 5.Department of NeurosurgeryNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  6. 6.Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  7. 7.Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  8. 8.Department of NephrologyNagasaki Renal CenterNagasakiJapan

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