Clinical Profile and Outcome of Intracranial Bleeding in Patients Undergoing Hemodialysis at a Tertiary Hospital

Abstract

Background: Stroke is one of the leading causes of mortality in the dialysis population. Although there is plenty of literature available for cardiovascular risk factors in dialysis patients, very few studies have focused on cerebrovascular events and Indian data are sparse. Objectives: This study was undertaken to address some of these shortcomings. Methods: This is a matched cohort study. There were 30 cases with intracranial bleeding (ICB) in hemodialysis patients whose clinical profiles were compared with 60 matched controls with no ICB and the data was analyzed. Results: The common cause of chronic kidney disease (CKD) was diabetes. Event BP was high but not significantly. Serum albumin values were lower in patients than in controls (2.65 vs. 3.15 g/dL). The common site of bleeding in our study was intraparenchymal (60%), followed by subdural hematoma (30%). Mortality was 76.7% in one month. Although the incidence of bleeding was slightly more in the thrice-weekly dialysis group, the difference was not significant. The diabetic status of ICB patients was poorly controlled. Conclusions: Hemodialysis patients have multiple risk factors for ICB and low serum albumin could be one of them. These patients have high short-term mortality (76.7%). There was a slightly increased incidence of ICB in patients who underwent thrice-weekly dialysis and those with poor glycemic control. This needs a systemic study with larger sample size and longer follow-up.The present study focused on intracranial bleeding (ICB) in dialysis patients by analyzing the clinical profile, various associated risk factors, and the impact of ICB on short-term patient survival. MethodsThis case-control study was undertaken at St. John Medical College, Bangalore, India, over a span of three years. This tertiary care hospital caters to people across all socioeconomic strata. The study included patients with CKD on long-term maintenance hemodialysis at St. Johns who either suffered ICB in the hospital or came to the emergency with the event. Those with ischemic stroke were excluded. We recorded clinical features such as vital signs, Glasgow coma score, comorbid diseases, viral serology, hemogram, blood biochemistry including liver and renal panel, and coagulation profile. The CT/MRI reports were noted for the site of ICB, the size of bleeding, and intraventricular