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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2015 | Original research

Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury

Authors: Hsin-Hung Chen, Chien-Chin Hsu, Shih-Feng Weng, Hung-Jung Lin, Jhi-Joung Wang, How-Ran Guo, Shih-Bin Su, Chien-Cheng Huang, Jiann-Hwa Chen

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2015

Abstract

Background

Hemodialysis (HD) treatment for end-stage renal disease (ESRD) (HD^+ESRD) may increase the risk of intracranial hemorrhage (ICH) after a head injury (HI) for which heparin is used. However, the results of noncontrast head computed tomography (CT) in such patients are not always clear. We aimed to evaluate the effect of HD on the risk of ICH in ESRD patients and in controls without ESRD with HD (HD^−ESRD), and to determine whether to lower the threshold of head CT in HD^+ESRD patients after HI.

Methods

In this nationwide population-based study using Taiwan’s National Health Insurance Research Database, we enrolled 6938 HD^+ESRD HI patients for the case group and 13,876 randomly selected HD^−ESRD HI patients for the control group. Measures of the post-HI association between HD^+ESRD and ICH determined using conditional logistic regression.

Results

Five hundred sixty-eight (2.74 %) patients had post-HI ICH: 185 in the HD^+ESRD group (2.67 % of cases) and 383 were from the HD^−ESRD group (2.76 % of controls). Conditional logistic regression analysis revealed that after adjusting for age, gender, diabetes, hypertension, congestive heart failure, stroke, cancer, and liver disease, HD^+ESRD patients had no higher odds of ICH (adjusted odds ratio [AOR]: 0.91; 95 % confidence interval [CI]: 0.75–1.11) than did HD^−ESRD patients. In the subgroup analysis of immediate ICH, HD^+ESRD patients had lower odds than did HD^−ESRD patients (AOR: 0.73; 95 % CI: 0.56–0.94).

Conclusions

HD^+ESRD did not increase the post-HI risk of ICH. Therefore, it may not be necessary to lower the threshold of head CT in HD^+ESRD patients.

Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012;59(1 Suppl 1):A7. e1-e420.CrossRefPubMed

Kuo HW, Tsai SS, Tiao MM, Yang CY. Epidemiological features of CKD in Taiwan. Am J Kidney Dis. 2007;49:46–55.CrossRefPubMed

U.S. Renal Data System. USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; 2005.

Khan F, Baguley IJ, Cameron ID. 4: Rehabilitation after traumatic brain injury. Med J Aust. 2003;178:290–5.PubMed

Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7:728–41.CrossRefPubMed

Langlois JA, Sattin RW. Traumatic brain injury in the United States: research and programs of the Centers for Disease Control and Prevention (CDC). J Head Trauma Rehabil. 2005;20:187–8.CrossRefPubMed

Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien). 2006;148:255–68.CrossRef

Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9:231–6.CrossRefPubMed

Jagoda AS, Bazarian JJ, Bruns Jr JJ, Cantrill SV, Gean AD, Howard PK, et al. Clinical policy: neuroimaging and decisionmaking in adult mild brain injury in the acute setting. Ann Emerg Med. 2008;52:714–48.CrossRefPubMed

10.

Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor HI. N Engl J Med. 2000;343:100–5.CrossRefPubMed

11.

Stiell IG, Laupacis A, Wells GA, Canadian CT Head and Cervical-Spine Study Group. Indications for computed tomography after minor head injury. Canadian CT Head and Cervical-Spine Study Group. N Engl J Med. 2000;343:1570–1.CrossRefPubMed

12.

Cheng TM. Taiwan’s national health insurance system: high value for the dollar. In: Okma KG, Crivelli L, editors. Six Countries, Six Reform Models—the Healthcare Reform Experience of Israel, the Netherlands, New Zealand, Singapore, Switzerland and Taiwan. Hackensack, NJ: World Scientific; 2009. p. 171–204.CrossRef

13.

Huang CC, Chung MH, Weng SF, Chien CC, Lin SJ, Lin HJ, et al. Long-term prognosis of patients with carbon monoxide poisoning: a nationwide cohort study. PLoS ONE. 2014;9:e105503.PubMedCentralCrossRefPubMed

14.

Nelson DL, Cox MM. Lehninger Pinciples of Biochemistry. Fourthth ed. New York: W. H. Freeman (Macmillan Education); 2004. p. 1100.

15.

Lim W, Cook DJ, Crowther MA. Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials. J Am Soc Nephrol. 2004;15:3192–206.CrossRefPubMed

16.

Sonawane S, Kasbekar N, Berns JS. The safety of heparins in end-stage renal disease. Semin Dial. 2006;19:305–10.CrossRefPubMed

17.

Ouseph R, Ward RA. Anticoagulation for intermittent hemodialysis. Semin Dial. 2000;13:181–7.CrossRefPubMed

18.

Kawamura M, Fijimoto S, Hisanaga S, Yamamoto Y, Eto T. Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis. Am J Kidney Dis. 1998;31:991–6.CrossRefPubMed

19.

Sood P, Sinson GP, Cohen EP. Subdural hematomas in chronic dialysis patients: significant and increasing. Clin J Am Soc Nephrol. 2007;2:956–9.CrossRefPubMed

20.

Hayashi H, Kurata Y, Imanaga Y, Goya K, Oshima K. Vitrectomy for diabetic retinopathy in patients undergoing hemodialysis for associated end-stage renal failure. Retina. 1998;18:156–9.PubMed

21.

Nawrocki J, Chrzanowski W, Koch D, Dziegielewski K. Vitreoretinal surgery in diabetic patients on hemodialysis. Eur J Ophthalmol. 1997;7:283–7.PubMed

22.

Cherng YG, Liao CC, Chen TH, Xiao D, Wu CH, Chen TL. Are non-cardiac surgeries safe for dialysis patients? − A population-based retrospective cohort study. PLoS ONE. 2013;8:e58942.PubMedCentralCrossRefPubMed

23.

Papa L, Stiell IG, Clement CM, Pawlowicz A, Wolfram A, Braga C, et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med. 2012;19:2–10.CrossRefPubMed

24.

Wolf H, Machold W, Frantal S, Kecht M, Pajenda G, Leitgeb J, et al. Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule. J Neurosurg. 2014;120:447–52.CrossRefPubMed

25.

Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012;59:460–8. e1-7.PubMedCentralCrossRefPubMed

26.

Liao JC, Ho CH, Liang FW, Wang JJ, Lin KC, Chio CC, et al. One-year mortality associations in hemodialysis patients after traumatic brain injury--an eight-year population-based study. PLoS ONE. 2014;9:e93956.PubMedCentralCrossRefPubMed

27.

Gomes EP, Reboredo MM, Carvalho EV, Teixeira DR, Carvalho LF, Filho GF, et al. Physical activity in hemodialysis patients measured by triaxial accelerometer. Biomed Res Int. 2015;2015:645645.PubMedCentralCrossRefPubMed

28.

Shen JI, Mitani AA, Chang TI, Winkelmayer WC. Use and safety of heparin-free maintenance hemodialysis in the USA. Nephrol Dial Transplant. 2013;28:1589–602.PubMedCentralCrossRefPubMed

Title: Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury
Authors: Hsin-Hung Chen
Chien-Chin Hsu
Shih-Feng Weng
Hung-Jung Lin
Jhi-Joung Wang
How-Ran Guo
Shih-Bin Su
Chien-Cheng Huang
Jiann-Hwa Chen
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2015
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-015-0168-1

At a glance: The STEP trials

Springer Medicine

Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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