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Yang L, Li Z, Dai X, Wang L, Wang X, Liu H. Nontraumatic subdural hematoma in patients on hemodialysis with end-stage kidney disease: a systematic review and pooled analysis. Front Neurol 2023; 14:1251652. [PMID: 37789893 PMCID: PMC10542405 DOI: 10.3389/fneur.2023.1251652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Background The original treatment may aggravate when hemodialysis (HD) patients have nontraumatic subdural hematoma (NSDH). End-stage kidney disease patients are at increased risk for NSDH, but its risk factors and outcomes are not sufficiently explored at present. Methods Electronic databases, including PubMed, EMBASE, and Web of Science were searched by using various combinations of the keywords "Hemodialysis," "Renal Insufficiency," "Extracorporeal Dialysis," "Subdural Hematoma," "Subdural Hemorrhage," "Subdural Hematomas," and "Subdural Hemorrhages" in accordance with the PRISMA guidelines. Sixteen papers were selected. Relevant patient data were extracted, aggregated, and analyzed. Results A total of 74 patients were analyzed, including 37 male, 26 female, and 11 with no gender data, with a mean age of 56 years (range, 16-81 years). There were 43 patients with hypertension, 36 patients with diabetes, 16 patients who used oral anticoagulants before dialysis, and 10 patients with atrial fibrillation. The diagnosis of subdural hematoma (SDH) was made by computed tomography (CT) (n = 51), carotid arteriography (n = 7), surgical exploration (n = 3), and autopsy (n = 2). Forty cases underwent surgical treatment, including craniotomy and burr hole (or twist drill) drainage. The 1 year mortality rate of NSDH was 45.9%. The mortality rate after conservative treatment (61.8%) was higher than that after surgical intervention (32.5%). The mortality rate of NSDH in dialysis patients with atrial fibrillation and in those who used oral anticoagulants before hemodialysis (HD) was 90 and 81%, respectively. Conclusion NSDH is rare in HD, and mortality is high if NSDH occurs in dialysis patients. Surgical intervention reduces the mortality from NSDH in patients on HD (p < 0.02). Patients with atrial fibrillation and those who were taking oral anticoagulants before dialysis have a higher NSDH mortality (p < 0.01).
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Affiliation(s)
- Liling Yang
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Zongping Li
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xiaoyu Dai
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Lijun Wang
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Xiaoyi Wang
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hongyuan Liu
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
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He F, Zhang D, Chen Q, Zhao Y, Wu L, Li Z, Zhang C, Jiang Z, Wang Y. Angiopoietin‐Tie signaling in kidney diseases: an updated review. FEBS Lett 2019; 593:2706-2715. [PMID: 31380564 DOI: 10.1002/1873-3468.13568] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Fang‐Fang He
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Di Zhang
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Qing Chen
- Department of Hepatobiliary Surgery Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yi Zhao
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Liang Wu
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Zhen‐Qiong Li
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Chun Zhang
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Zhao‐Hua Jiang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yu‐Mei Wang
- Department of Nephrology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
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Dahdaleh S, Malhotra P. Treatment of Central Nervous System Complications of Renal Dialysis and Transplantation. Curr Treat Options Neurol 2019; 21:13. [DOI: 10.1007/s11940-019-0553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Effects of Pre-Existing Comorbidities on Outcomes in Patients with Chronic Subdural Hematoma. World Neurosurg 2018; 122:e924-e932. [PMID: 30408607 DOI: 10.1016/j.wneu.2018.10.176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The number of patients with chronic subdural hematoma (CSDH) showing comorbidities and/or impaired activities of daily living (ADL) before the onset of CSDH has increased with the recent aging of society. The purposes of this study were to evaluate ADL worsening by comparing premorbid ADL and ADL at discharge and to investigate the effects of pre-existing comorbidity-related clinical factors on the outcomes. METHODS A total of 570 patients with CSDH admitted from 2006 to 2016 were studied retrospectively. Clinical factors, including pre-existing comorbidities, related to outcomes were identified by multivariate analysis. A variation of the modified Rankin Scale (mRS) using 5 united categories of mRS scores 0/1, 2, 3/4, 5, and dead was used for evaluation of ADL. RESULTS Of 570 patients, 390 (68.4%) had pre-existing comorbidities and 120 (21.1%) showed premorbid impaired ADL (mRS scores 2 and worse). Considering pre-existing impaired ADL, ADL deteriorated after CSDH in 92 patients (16.1%), whereas ADL impairment at discharge was found in 173 patients (30.4%). Comorbidities related to ADL deterioration on multivariate analysis were hemodialysis and chronic heart failure. Antithrombotic use for cardiovascular diseases was a predictor of acute-on-chronic subdural hematoma, which was the sole common predictor for ADL deterioration and the occurrence of surgical complications. CONCLUSIONS In patients with CSDH, pre-existing comorbidity-linked factors related to outcomes were hemodialysis, chronic heart failure, and antithrombotic use. Patients with acute-on-chronic subdural hematoma with these factors should be regarded as a high-risk group.
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Karunaratne K, Taube D, Khalil N, Perry R, Malhotra PA. Neurological complications of renal dialysis and transplantation. Pract Neurol 2017; 18:115-125. [PMID: 29288211 DOI: 10.1136/practneurol-2017-001657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/04/2022]
Abstract
Neurological complications from renal replacement therapy contribute significantly to morbidity and mortality in patients with renal failure. Such complications can affect either the central or peripheral nervous systems. Most neurological disturbances associated with the uraemic state do not respond fully to renal replacement therapy. There are also complications specifically associated with dialysis and transplantation. A multidisciplinary approach, involving both nephrologists and neurologists, is critical for the diagnosis and effective management of these disorders.
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Affiliation(s)
- Kushan Karunaratne
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - David Taube
- Department of Renal and Transplantation Medicine, West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, London, UK
| | - Nofal Khalil
- Department of Neurophysiology, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Perry
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK.,Division of Brain Sciences, Imperial College London, London, UK
| | - Paresh A Malhotra
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK.,Division of Brain Sciences, Imperial College London, London, UK
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Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med 2017; 35:1946-1955. [PMID: 28893450 DOI: 10.1016/j.ajem.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. DISCUSSION ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. CONCLUSIONS Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.
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Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Courtney M Lee
- Joint Base Elmendorf Richardson Medical Center, Department of Emergency Medicine, 5955 Zeamer Ave, JBER, AK, 99506, United States
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Uno M, Toi H, Hirai S. Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign? Neurol Med Chir (Tokyo) 2017; 57:402-409. [PMID: 28652561 PMCID: PMC5566699 DOI: 10.2176/nmc.ra.2016-0337] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH. The literature actually offers conflicting advice regarding CSDH treatment; however, burr hole surgery with drainage under local anesthesia is the most common surgical procedure, even in elderly patients. The recurrence rate of CSDH has not decreased over recent decades, and it has ranged from 0.36-33.3%. Outcomes in patients over 75 years old was significantly worse than for those younger than 75. Moreover, long-term outcomes for elderly patients with CSDH are poor. CSDH in the elderly is no longer a benign disease. In the future, it will be important for us to understand the mechanisms of onset and recurrence of CSDH and to develop more effective medical treatments and noninvasive surgical techniques for elderly patients.
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Affiliation(s)
- Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School
| | - Hiroyuki Toi
- Department of Neurosurgery, Kawasaki Medical School
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8
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Murea M, Russell GB, Daeihagh P, Saran AM, Pandya K, Cabrera M, Burkart JM, Freedman BI. Efficacy and safety of low-dose heparin in hemodialysis. Hemodial Int 2017; 22:74-81. [DOI: 10.1111/hdi.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Gregory B. Russell
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Pirouz Daeihagh
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Anita M. Saran
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Karan Pandya
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Mark Cabrera
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - John M. Burkart
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
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Nochaiwong S, Ruengorn C, Awiphan R, Dandecha P, Noppakun K, Phrommintikul A. Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis. Open Heart 2016; 3:e000441. [PMID: 27386140 PMCID: PMC4916629 DOI: 10.1136/openhrt-2016-000441] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/23/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023] Open
Abstract
Objective To systematically review and meta-analyse the risk–benefit ratio of warfarin users compared with non-warfarin users in patients with atrial fibrillation (AF), who are undergoing dialysis. Methods We searched PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library, grey literature, conference proceedings, trial registrations and also did handsearch. Cohort studies without language restrictions were included. Two investigators independently conducted a full abstraction of data, risk of bias and graded evidence. Effect estimates were pooled using random-effect models. Main outcome measure All-cause mortality, total stroke/thromboembolism and bleeding complications. Results 14 studies included 37 349 dialysis patients with AF, of whom 12 529 (33.5%) were warfarin users. For all-cause mortality: adjusted HR=0.99 (95% CI 0.89 to 1.10; p=0.825), unadjusted risk ratio (RR)=1.00 (95% CI 0.96 to 1.04; p=0.847). For stroke/thromboembolism: adjusted HR=1.06 (95% CI 0.82 to 1.36; p=0.676), unadjusted incidence rate ratio (IRR)=1.23 (95% CI 0.94 to 1.61; p=0.133). For ischaemic stroke/transient ischaemic attack, adjusted HR=0.91 (95% CI 0.57 to 1.45; p=0.698), unadjusted IRR=1.16 (95% CI 0.84 to 1.62; p=0.370). For haemorrhagic stroke, adjusted HR=1.60 (95% CI 0.91 to 2.81; p=0.100), unadjusted IRR=1.48 (95% CI 0.92 to 2.36; p=0.102). Major bleeding was increased among warfarin users; adjusted HR=1.35 (95% CI 1.11 to 1.64; p=0.003) and unadjusted IRR=1.22 (95% CI 1.07 to 1.40; p=0.003). Conclusions Among dialysis patients with AF, warfarin therapy was not associated with mortality and stroke/thromboembolism, but significantly increased the risk of major bleeding. More rigorous studies are essential to demonstrate the effect of warfarin for stroke prophylaxis in dialysis patients with AF.
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Affiliation(s)
- Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Clinic, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Clinic, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Rattanaporn Awiphan
- Department of Pharmaceutical Care, Faculty of Pharmacy , Chiang Mai University , Chiang Mai , Thailand
| | - Phongsak Dandecha
- Division of Nephrology, Department of Internal Medicine , Prince of Songkla University , Hat Yai, Songkhla , Thailand
| | - Kajohnsak Noppakun
- Renal Division, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
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Takata T, Kokudo Y, Kume K, Ikeda K, Kamada M, Touge T, Deguchi K, Masaki T. Dialysis-induced Subdural Hematoma in an Arachnoid Cyst Associated with Autosomal Dominant Polycystic Kidney Disease. Intern Med 2016; 55:2065-7. [PMID: 27477416 DOI: 10.2169/internalmedicine.55.6295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Arachnoid cyst (AC) is a neurological complication of autosomal dominant polycystic kidney disease (ADPKD). Although an AC can increase the risk of a subdural hematoma, the clinical presentation of bleeding into an AC associated with ADPKD is not well known. We herein report the case of a 59-year-old woman in whom the initiation of hemodialysis for renal failure led to AC bleeding. A change of anticoagulant from heparin to nafamostat mesilate allowed dialysis to continue without rebleeding. These findings suggest that hemodialysis in patients with an AC associated with ADPKD may increase the risk of bleeding. Nafamostat mesilate may be useful in such cases.
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Affiliation(s)
- Tadayuki Takata
- Department of Intractable Neurological Research, Kagawa University Faculty of Medicine, Japan
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Honda Y, Sorimachi T, Momose H, Takizawa K, Inokuchi S, Matsumae M. Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma. Neurol Res 2015; 37:985-92. [PMID: 26344395 DOI: 10.1179/1743132815y.0000000083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Detailed features of chronic subdural haematoma (cSDH) associated with disturbance of consciousness and acute-on-chronic subdural haematoma (a/cSDH), in which acute subdural haematoma overlaps cSDH, remain poorly understood. The object of this study was to clarify both characteristics of cSDH associated with disturbance of consciousness and the significance of a/cSDH. METHODS Clinical factors and computed tomography (CT) findings were retrospectively investigated in 349 consecutive patients admitted between 2006 and 2013 and diagnosed with cSDH. RESULTS Glasgow Coma Scale (GCS) was ≤ 8 in 21 patients (6.0%) and 9-14 in 29 patients excluding aphasia and/or dementia (8.3%). Multiple logistic regression analysis indicated that a/cSDH, female sex and haemodialysis were significantly related to severe disturbance of consciousness (GCS ≤ 8). Predictors for a/cSDH observed in 29 patients (8.3%) were trauma history within 7 days before admission, high prothrombin time-international rate, and use of anticoagulants and/or antiplatelets. Unfavourable outcomes were observed in 29 of 299 patients (9.7%) without consciousness disturbance, compared to 27 of 50 patients (54%) with consciousness disturbance. Predictors of unfavourable outcome were consciousness disturbance, increase in age, malignancy, trauma history within 7 days and haemodialysis. DISCUSSION Disturbance of consciousness associated with cSDH, often caused by either a/cSDH or concomitant disease, frequently resulted in unfavourable outcomes. As a result, in cSDH patients associated with disturbance of consciousness, underlying conditions, especially a/cSDH, which is often caused by haemostatic abnormality, should be clarified and managed.
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Wang IK, Cheng YK, Lin CL, Peng CL, Chou CY, Chang CT, Yen TH, Huang CC, Sung FC, Hsu CY. Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD. Clin J Am Soc Nephrol 2015; 10:994-1001. [PMID: 25825482 DOI: 10.2215/cjn.08140814] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 02/02/2015] [Indexed: 12/13/2022]
Abstract
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 (34.7 [95% CI, 31.4 to 35.4] versus 21.5 [95% CI, 20.2 to 22.9] per 10,000 person-years, with an adjusted hazard ratio of 1.62 [95% CI, 1.17 to 2.33]). Approximately 152 of 253 (60%) of SDH events were associated with trauma. Subsequent 30-day SDH-related mortality was not statistically higher in HD patients than in PD patients (29.1% versus 25.3%; adjusted odds ratio, 1.30; 95% CI, 0.70 to 2.41). 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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Affiliation(s)
- I-Kuan Wang
- Department of Internal Medicine and Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan; Divisions of Nephrology and
| | | | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chiao-Ling Peng
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan;
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan; Department of Neurology, and
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13
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Anticoagulant and antiplatelet therapy in patients with chronic kidney disease: risks versus benefits review. Curr Opin Nephrol Hypertens 2014; 22:624-8. [PMID: 24100216 DOI: 10.1097/mnh.0b013e328365adca] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation and cardiovascular death are increased in end-stage renal disease (ESRD) patients compared to the general population. The effect of anticoagulant and antiplatelet medications for these indications in ESRD is unclear. However, both classes of medications have been used for the preservation of vascular access. This review explores the risks and benefits of anticoagulant and antiplatelet medications in ESRD. RECENT FINDINGS ESRD patients with atrial fibrillation have a two and three-fold greater risk of death and stroke, respectively, than ESRD patients without atrial fibrillation. Warfarin does not appear to decrease this risk, and increases the risk of bleeding and vascular calcification. Warfarin also does not appear to be effective for vascular access preservation. In a few large observational studies, antiplatelet agents did not decrease the risk of cardiovascular death, but confounding by indication is likely. Antiplatelet agents do appear to prolong unassisted arteriovenous graft patency, but the effect is modest. SUMMARY The role of anticoagulant and antiplatelet agents for atrial fibrillation and cardiovascular disease in ESRD remains unclear. Well designed randomized controlled trials to determine the role of anticoagulation in ESRD patients with atrial fibrillation, and anticoagulant and antiplatelet medications in the preservation of central venous catheter function are required.
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Davenport A. Changing the hemodialysis prescription for hemodialysis patients with subdural and intracranial hemorrhage. Hemodial Int 2014; 17 Suppl 1:S22-7. [PMID: 24134327 DOI: 10.1111/hdi.12085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although continuous modalities of renal replacement therapy offer an advantage to the patient with compromised cerebral perfusion and intracranial hypertension, they are generally limited to the intensive care unit setting. Many hemodialysis patients admitted with strokes and subdural hematoma are managed on general wards. As such, these patients are generally treated by intermittent hemodialysis, and their dialysis prescription should be altered to minimize changes in serum osmolality, and fall in blood pressure during dialysis. Such patients require more frequent but shorter dialysis sessions, using minimally bioincompatible small surface area dialyzers with lower blood flows, in combination with higher sodium and cooled dialysate. In patients at risk of intracranial hemorrhage and those with invasive intracranial monitoring, systemic anticoagulants should be avoided, choosing no anticoagulation protocols or regional anticoagulants.
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Affiliation(s)
- Andrew Davenport
- UCL Center for Nephrology, University College London Medical School, London, UK
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15
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Neurologic complications of acute and chronic renal disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:383-93. [PMID: 24365307 DOI: 10.1016/b978-0-7020-4086-3.00024-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is an increasing incidence and prevalence of patients with chronic kidney disease (CKD) in Western industrialized countries and currently is estimated at approximately 10% of adults aged over 20 years. Renal failure causes an excessively increased risk of cerebrovascular and cardiovascular complications. Moreover, renal failure leads to a number of the neurologic symptoms neurologists are often confronted with. This chapter gives an overview of possible neurologic complications of acute renal failure and CKD. Complications of the central nervous system (e.g., uremic encephalopathy, disequilibrium syndrome, and drug induced disorders) are reviewed. It has long been known that uremia leads to peripheral nerve injury. Frequent neurological diseases such as uremic polyneuropathy, autonomic neuropathy, and a range of mononeuropathies are discussed.
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16
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Wang IK, Lin CL, Wu YY, Kuo HL, Lin SY, Chang CT, Yen TH, Chuang FR, Cheng YK, Huang CC, Sung FC. Subdural hematoma in patients with end-stage renal disease receiving hemodialysis. Eur J Neurol 2014; 21:894-900. [PMID: 24689932 DOI: 10.1111/ene.12406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/07/2014] [Indexed: 12/01/2022]
Affiliation(s)
- I.-K. Wang
- Graduate Institute of Clinical Medical Science; China Medical University College of Medicine; Taichung Taiwan
- Department of Internal Medicine; China Medical University College of Medicine; Taichung Taiwan
- Division of Nephrology; China Medical University Hospital; Taichung Taiwan
| | - C.-L. Lin
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Department of Public Health; China Medical University; Taichung Taiwan
| | - Y.-Y. Wu
- Department of Medical Laboratory Science and Biotechnology; China Medical University; Taichung Taiwan
| | - H.-L. Kuo
- Division of Nephrology; China Medical University Hospital; Taichung Taiwan
| | - S.-Y. Lin
- Division of Nephrology; China Medical University Hospital; Taichung Taiwan
| | - C.-T. Chang
- Division of Nephrology; China Medical University Hospital; Taichung Taiwan
| | - T.-H. Yen
- Division of Nephrology; Chang Gung Memorial Hospital; Taipei Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - F.-R. Chuang
- Division of Nephrology; Kaohsiung Chang Gung Memorial Hospital Medical Center; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Y.-K. Cheng
- Division of Neurosurgery; China Medical University Hospital; Taichung Taiwan
| | - C.-C. Huang
- Division of Nephrology; China Medical University Hospital; Taichung Taiwan
| | - F.-C. Sung
- Graduate Institute of Clinical Medical Science; China Medical University College of Medicine; Taichung Taiwan
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Department of Public Health; China Medical University; Taichung Taiwan
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17
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Lee CH. Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chul-Hee Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
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18
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Brown EA, Johansson L. Epidemiology and management of end-stage renal disease in the elderly. Nat Rev Nephrol 2011; 7:591-8. [DOI: 10.1038/nrneph.2011.113] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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