Advertisement

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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Cerebral hemorrhage Hemodialysis Blood pressure elevation Serum calcium 

Notes

Acknowledgements

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)

References

  1. 1.
    Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet. 2014;383:1899–911.CrossRefGoogle Scholar
  2. 2.
    Li W, Jin C, Vaidya A, Wu Y, Rexrode K, Zheng X, et al. Blood pressure trajectories and the risk of intracerebral hemorrhage and cerebral infarction: a prospective study. Hypertension. 2017;70:508–14.CrossRefGoogle Scholar
  3. 3.
    Ritchie J, Rainone F, Green D, Alderson H, Chiu D, Middleton R, et al. Extreme elevations in blood pressure and all-cause mortality in a referred CKD population: results from the CRISIS study. Int J Hypertens. 2013.  https://doi.org/10.1155/2013/597906.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Xiao M, Li Q, Feng H, Zhang L, Chen Y. Neural vascular mechanism for the cerebral blood flow autoregulation after hemorrhagic stroke. Neural Plast. 2017.  https://doi.org/10.1155/2017/5819514.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ito A, Omae T, Katsuki S. Acute changes in blood pressure following vascular diseases in the brain stem. Stroke. 1973;4:80–4.CrossRefGoogle Scholar
  6. 6.
    Wakasugi M, Matsuo K, Kazama JJ, Narita I. Higher mortality due to intracerebral hemorrhage in dialysis patients: a comparison with the general population in Japan. Ther Apher Dial. 2015;19:45–9.CrossRefGoogle Scholar
  7. 7.
    Kawamura M, Fijimoto S, Hisanaga S, Yamamoto Y, Eto T. Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis. Am J Kidney Dis. 1998;31:991–6.CrossRefGoogle Scholar
  8. 8.
    Yamada S, Tsuruya K, Taniguchi M, Tokumoto M, Fujisaki K, Hirakata H, et al. Association between serum phosphate levels and stroke risk in patients undergoing hemodialysis: the Q-Cohort Study. Stroke. 2016;47:2189–96.CrossRefGoogle Scholar
  9. 9.
    Port FK, Hulbert-Shearon TE, Wolfe RA, Bloembergen WE, Golper TA, Agodoa LY, et al. Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis. 1999;33:507–17.CrossRefGoogle Scholar
  10. 10.
    Turner JM, Peixoto AJ. Blood pressure targets for hemodialysis patients. Kidney Int. 2017;92:816–23.CrossRefGoogle Scholar
  11. 11.
    Naganuma T, Takemoto Y, Shoji T, Ishimura E, Okamura M, Nakatani T. Cerebral microbleeds predict intracerebral hemorrhage in hemodialysis patients. Stroke. 2015;46:2107–12.CrossRefGoogle Scholar
  12. 12.
    Jafari M, Di Napoli M, Datta YH, Bershad EM, Divani AA. The role of serum calcium level in intracerebral hemorrhage hematoma expansion: is there any? Neurocrit Care. 2018;31:188–95.CrossRefGoogle Scholar
  13. 13.
    Kitamura M, Tateishi Y, Sato S, Kitamura S, Ota Y, Muta K, et al. Association between serum calcium levels and prognosis, hematoma volume, and onset of cerebral hemorrhage in patients undergoing hemodialysis. BMC Nephrol. 2019;20:210.CrossRefGoogle Scholar
  14. 14.
    Beierwaltes WH. The role of calcium in the regulation of renin secretion. Am J Physiol Ren Physiol. 2010;298:F1–F11.CrossRefGoogle Scholar
  15. 15.
    Smajilovic S, Yano S, Jabbari R, Tfelt-Hansen J. The calcium-sensing receptor and calcimimetics in blood pressure modulation. Br J Pharmacol. 2011;164:884–93.CrossRefGoogle Scholar
  16. 16.
    Rahman M, Fu P, Sehgal AR, Smith MC. Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients. Am J Kidney Dis. 2000;35:257–65.CrossRefGoogle Scholar
  17. 17.
    Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24:987–93.CrossRefGoogle Scholar
  18. 18.
    Brott T, Marler JR, Olinger CP, Adams HP Jr, Tomsick T, Barsan WG, et al. Measurements of acute cerebral infarction: lesion size by computed tomography. Stroke. 1989;20:871–5.CrossRefGoogle Scholar
  19. 19.
    Sulter G, Steen C, De Keyser J. Use of the Barthel Index and modified Rankin Scale in acute stroke trials. Stroke. 1999;30:1538–41.CrossRefGoogle Scholar
  20. 20.
    Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973;4:643–6.CrossRefGoogle Scholar
  21. 21.
    Flythe JE, Kunaparaju S, Dinesh K, Cape K, Feldman HI, Brunelli SM. Factors associated with intradialytic systolic blood pressure variability. Am J Kidney Dis. 2012;59:409–18.CrossRefGoogle Scholar
  22. 22.
    Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med. 2011;365:1099–107.CrossRefGoogle Scholar
  23. 23.
    Inoue Y, Miyashita F, Toyoda K, Minematsu K. Low serum calcium levels contribute to larger hematoma volume in acute intracerebral hemorrhage. Stroke. 2013;44:2004–6.CrossRefGoogle Scholar
  24. 24.
    Morotti A, Charidimou A, Phuah CL, Jessel MJ, Schwab K, Ayres AM, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73:1285–90.CrossRefGoogle Scholar
  25. 25.
    Hill MA, Sun Z, Martinez-Lemus L, Meininger GA. New technologies for dissecting the arteriolar myogenic response. Trends Pharmacol Sci. 2007;28:308–15.CrossRefGoogle Scholar
  26. 26.
    Howarth C. The contribution of astrocytes to the regulation of cerebral blood flow. Front Neurosci. 2014;8:103.CrossRefGoogle Scholar
  27. 27.
    Shroff RC, McNair R, Skepper JN, Figg N, Schurgers LJ, Deanfield J, et al. Chronic mineral dysregulation promotes vascular smooth muscle cell adaptation and extracellular matrix calcification. J Am Soc Nephrol. 2010;21:103–12.CrossRefGoogle Scholar
  28. 28.
    Moe SM, Drueke TB, Group for the KW. KDIGO 2017 clinical practice guideline for the diagnosis, evaluation, prevention and treatment of chronic kidney disease mineral and bone disorder (CKD-MBD). Kidney Int. 2017;76:S1–128.Google Scholar
  29. 29.
    Kim ED, Watt J, Tereshchenko LG, Jaar BG, Sozio SM, Kao WHL, et al. Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study. BMC Nephrol. 2019;20:133.CrossRefGoogle Scholar
  30. 30.
    Charytan DM, Foley R, McCullough PA, Rogers JD, Zimetbaum P, Herzog CA, et al. Arrhythmia and sudden death in hemodialysis patients: protocol and baseline characteristics of the monitoring in dialysis study. Clin J Am Soc Nephrol. 2016;11:721–34.CrossRefGoogle Scholar
  31. 31.
    Eisner DA, Caldwell JL, Kistamás K, Trafford AW. Calcium and excitation-contraction coupling in the heart. Circ Res. 2017;121:181–95.CrossRefGoogle Scholar

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

Personalised recommendations