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

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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.

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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)

Author information

Authors and Affiliations

  1. Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan

    Mineaki Kitamura & Yasushi Mochizuki

  2. Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Mineaki Kitamura, Yuki Ota, Kumiko Muta, Tadashi Uramatsu & Tomoya Nishino

  3. Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan

    Yohei Tateishi & Akira Tsujino

  4. Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan

    Shuntaro Sato

  5. Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Tsuyoshi Izumo & Takayuki Matsuo

  6. Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Yasushi Mochizuki & Hideki Sakai

  7. Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Hiroshi Mukae

  8. Department of Nephrology, Nagasaki Renal Center, Nagasaki, Japan

    Takashi Harada & Satoshi Funakoshi

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  1. Mineaki Kitamura
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  2. Yohei Tateishi
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Correspondence to Mineaki Kitamura.

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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.

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Kitamura, M., Tateishi, Y., Sato, S. et al. Lower serum calcium and pre-onset blood pressure elevation in cerebral hemorrhage patients undergoing hemodialysis. Clin Exp Nephrol 24, 465–473 (2020). https://doi.org/10.1007/s10157-020-01846-3

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  • DOI: https://doi.org/10.1007/s10157-020-01846-3

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