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首页> 外文期刊>Journal of nephrology. >Screening for transient ischemic attacks in hemodialysis patients
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Screening for transient ischemic attacks in hemodialysis patients

机译：血液透析患者短暂性脑缺血发作的筛查

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Background: Rapid recognition and management of transient ischemic attacks (TIAs) reduce incident strokes in the general population, but similar data are lacking in dialysis patients, who form a high-risk group for this pathology. We systematically screened hemodialysis patients for TIA to estimate its incidence and determine whether there was significant scope to reduce subsequent strokes by risk modification. Methods: Patients established on hemodialysis at a satellite dialysis unit at our center were screened prospectively using weekly symptom questionnaires over a 12-month period. Following clinical review, patients who screened positive were urgently referred to a TIA clinic, and all stroke and TIA and stroke events were recorded. Results: A total of 304 patients were screened over 2,594 total patient months of follow-up (1st November 2009 to 1st November 2010). Six strokes occurred, of which 5 were ischemic (a rate of 23.1/1,000 patientyears). No patients screened positive for a TIA, despite predicted rates of 4.2/1,000 patient-years (95% confidence interval, 1.4-9.7/1,000 patient-years). One ischemic stroke was preceded by symptoms compatible with a TIA, although this was ascertained in retrospect and not during screening. Conclusions: Based on the first study of its kind to date, systematic screening for TIA has a low yield and cannot be relied on alone to identify patients at higher risk of cerebrovascular events. The confounding presence of symptoms attributable to uremia, neuropathy, hypotension and dysglycemia could reduce the sensitivity of established tests, with significant implications for the detection and treatment of TIA in dialysis.
机译：背景：快速识别和管理短暂性脑缺血发作（TIA）可以减少普通人群的中风，但是透析患者缺乏类似的数据，而透析患者构成了这种病理的高风险人群。我们系统地对血液透析患者进行TIA筛查，以评估其发生率，并确定是否存在通过降低风险来减少后续卒中的重要范围。方法：在我们中心的卫星透析室对接受血液透析的患者进行前瞻性筛选，在12个月内使用每周症状问卷调查。经过临床检查后，筛查阳性的患者紧急转诊至TIA诊所，并记录了所有中风和TIA及中风事件。结果：总共对304例患者进行了2594个月的随访（2009年11月1日至2010年11月1日）。发生了6次中风，其中5次是缺血性（23.1 / 1,000患者年）。尽管预测的TIA率为4.2 / 1,000患者-年（95％置信区间为1.4-9.7 / 1,000患者-年），但没有患者筛查TIA阳性。一个缺血性中风之前会伴有与TIA兼容的症状，尽管这是回顾性确定的，而不是筛查时确定的。结论：基于迄今为止的同类研究，系统性TIA筛查的收率很低，不能仅仅依靠它来识别脑血管事件高风险的患者。尿毒症，神经病，低血压和血糖异常引起的症状的混杂存在可能会降低既定测试的敏感性，这对透析中TIA的检测和治疗具有重要意义。

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