Higher Mortality Due to Intracerebral Hemorrhage in Dialysis Patients: A Comparison with the General Population in Japan

Cerebrovascular diseases, including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, remain prevalent causes of morbidity and mortality among dialysis patients. Their mortality rate for cerebrovascular diseases is roughly three times higher than that in the general population. However, whether mortality rates for all subtypes of cerebrovascular diseases are equally higher has not been evaluated. The aim of this study was to determine the mortality rate for each stroke subtype, comparing dialysis patients and the general population in Japan. We used mortality data reported by the Japanese Society for Dialysis Therapy and national Vital Statistics data between 2008 and 2009. We calculated standardized mortality ratios and compared the mortality rates for stroke subtypes including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage. During the 2-year study period, 51994 and 933 deaths from intracerebral hemorrhage, 79124 and 511 deaths from cerebral infarction, and 24957 and 147 deaths from subarachnoid hemorrhage were recorded per 252 million person-years and per 546474 dialysis patient-years, respectively. Standardized mortality ratios among dialysis patients relative to the general population were 3.8 (95% confidence interval, 3.6-4.1), 1.3 (1.2-1.4), and 1.3 (1.1-1.6) for intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, respectively. Intracerebral hemorrhage was the highest cause of mortality in the dialysis population, although cerebral infarction was the highest in the general population. Relative to the general population in Japan, Japanese dialysis patients had higher mortality rates, especially for intracerebral hemorrhage.