Subdural Hematomas in Chronic Dialysis Patients

Sood, Puneet; Sinson, Grant; Cohen, Eric P.

doi:10.2215/cjn.03781106

Cited by 49 publications

(41 citation statements)

References 19 publications

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“…2 the US Renal Data System reported a 10-fold increase in subdural hemorrhages in dialysis patients (although their medication was not specified) when compared with nondialysis patients, 43 whereas a review of 28 studies of warfarin use in dialysis patients suggested its use doubled the risk for major bleeding. 44 Treated hypertension, 18 -20,45,46 cerebrovascular disease, 23 ischemic stroke, 21,47 serious heart disease, 23 renal insufficiency, 23,48 -50 and advanced age 25,49,[51][52][53] have been reported to potentiate bleeding during warfarin therapy and are highly prevalent in the dialysis population.…”

Section: Discussionmentioning

confidence: 99%

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

Chan

Lazarus²,

Thadhani³

et al. 2009

Journal of the American Society of Nephrology

398

381

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Use of warfarin, clopidogrel, or aspirin associates with mortality among patients with ESRD, but the risk-benefit ratio may depend on underlying comorbidities. Here, we investigated the association between these medications and new stroke, mortality, and hospitalization in a retrospective cohort analysis of 1671 incident hemodialysis patients with preexisting atrial fibrillation. We followed patient outcomes from the time of initiation of dialysis for an average of 1.6 yr. Compared with nonuse, warfarin use associated with a significantly increased risk for new stroke (hazard ratio 1.93; 95% confidence interval 1.29 to 2.90); clopidogrel or aspirin use did not associate with increased risk for new stroke. Analysis using international normalized ratio (INR) suggested a dose-response relationship between the degree of anticoagulation and new stroke in patients on warfarin (P ϭ 0.02 for trend). Warfarin users who received no INR monitoring in the first 90 d of dialysis had the highest risk for stroke compared with nonusers (hazard ratio 2.79; 95% confidence interval 1.65 to 4.70). Warfarin use did not associate with statistically significant increases in all-cause mortality or hospitalization. In conclusion, warfarin use among patients with both ESRD and atrial fibrillation associates with an increased risk for stroke. The risk is greatest in warfarin users who do not receive in-facility INR monitoring.

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Section: Discussionmentioning

confidence: 99%

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

Chan

Lazarus²,

Thadhani³

et al. 2009

Journal of the American Society of Nephrology

398

381

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“…Higher risk of gastrointestinal bleeding and subdural hematomas in this population have been described previously. 21,22 Defects in coagulation pathway and use of anticoagulation in dialysis are thought to contribute toward this increased risk of bleeding in patients on maintenance dialysis. We found the incidence of SAH hospitalizations to be higher in females and blacks irrespective of need for maintenance dialysis.…”

Section: Discussionmentioning

confidence: 99%

Nontraumatic Subarachnoid Hemorrhage in Maintenance Dialysis Hospitalizations

Sakhuja

Schold

Kumar

et al. 2014

Stroke

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Background and Purpose-Subarachnoid hemorrhage (SAH) is associated with high mortality, and patients on maintenance dialysis have been shown to be at higher risk for stroke including SAH. However, the outcomes of patients on maintenance dialysis with SAH are not well known. This study was designed to look at incidence and outcomes of SAH in those on maintenance dialysis. Methods-Using the Nationwide Inpatient Sample Database, hospitalizations with nontraumatic SAH were identified. Ageadjusted incidence rates were calculated by direct standardization to the 2000 US standard population. Logistic regression was used to assess the risk factors for mortality. Results-Of an estimated 149 091 hospitalizations with SAH, 1631 patients (10.9%) were on maintenance dialysis.Unadjusted incidence of SAH hospitalizations was higher in maintenance dialysis than in the general population (73.5 versus 11.2 per 100 000 population), and similar results were seen on age-adjusted analysis. The unadjusted all-cause inpatient mortality rate for SAH admissions was higher in maintenance dialysis versus the general population (38.4% versus 21.9%; P<0.001). Maintenance dialysis was an independent predictor of mortality (odds ratio, 2.48; 95% confidence interval, 1.85-3.34), although other significant predictors of mortality were similar in both subgroups. Incidence of SAH hospitalizations has been relatively stable during the study period, but mortality seems to be decreasing. Conclusions-SAH hospitalizations are more common and associated with higher mortality in patients on maintenance dialysis than in the general population. Although being on maintenance dialysis is an independent predictor for mortality in patients with SAH, other predictors of mortality evaluated in this study are not necessarily different between the 2 groups. (Stroke. 2014;45:71-76.)

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“…An earlier Japanese study found that acute SDH accounts for 8.6% of sudden deaths in patients receiving dialysis (11). Sood et al reported that the risk of nontraumatic SDH in long-term hemodialysis (HD) patients is 10-fold higher than that of the general United States population (10). We recently found that HD-treated patients with ESRD were at nearly 4 times higher risk of SDH than study participants without kidney disease (12).…”

Section: Introductionmentioning

confidence: 82%

“…Neurologic complications are important causes of morbidity and mortality in patients with ESRD (8). Studies also show that patients with ESRD are at higher risk of developing SDH (9)(10)(11)(12)). An earlier Japanese study found that acute SDH accounts for 8.6% of sudden deaths in patients receiving dialysis (11).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

Wang

Cheng

Lin

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives This study compared the risk of subdural hematoma (SDH) and subsequent mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients with ESRD.Design, setting, participants, & measurements Claims data were obtained from the National Health Insurance Administration Research Database in Taiwan. This retrospective cohort study comprised 10,136 PD patients and 10,136 HD patients with newly diagnosed ESRD from 1998 to 2010. Patients were matched by propensity score and year of dialysis initiation. Incidence rates and hazard ratios of SDH as well as odds ratios of subsequent 30-day deaths from SDH were evaluated from the date of the first dialysis session to the date when SDH was diagnosed, or the date of renal transplantation, death, withdraw from insurance, or the end of the follow-up period (December 31, 2011).Results Median (25th percentile, 75th percentile) follow-up times for SDH events were 3.61 years (1.91, 6.33) and 3.33 years (1.83, 5.66) in the HD and PD cohorts, respectively. The overall SDH incidence rate (95% confidence interval [95% CI]) was 61.4% higher in the HD cohort than in the PD cohort (34. Conclusions HD patients have a higher risk of developing SDH than PD patients. Both patient groups have a high risk of mortality. Routine education on fall prevention is needed for dialysis patients.

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Subdural Hematomas in Chronic Dialysis Patients

Cited by 49 publications

References 19 publications

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

Nontraumatic Subarachnoid Hemorrhage in Maintenance Dialysis Hospitalizations

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

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