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

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Jiann-Hwa Chen²  Chien-Cheng Huang⁷  Shih-Bin Su⁸  How-Ran Guo⁹  Jhi-Joung Wang⁵  Hung-Jung Lin⁴  Shih-Feng Weng¹  Chien-Chin Hsu⁶  Hsin-Hung Chen³ 

[1] Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan;Fu Jen Catholic University School of Medicine, Taipei, Taiwan;Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan;Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan;Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan;Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan;Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan;Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan;Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

关键词: Intracranial hemorrhage;    Hemodialysis;    Head injury;    Head CT;    End-stage renal disease;   

Others  :  1231198
DOI  :  10.1186/s13049-015-0168-1

 received in 2015-04-13, accepted in 2015-10-23,  发布年份 2015

【 摘 要 】

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 ^+ESRDpatients after HI.

Methods

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

Results

Five hundred sixty-eight (2.74 %) patients had post-HI ICH: 185 in the HD ^+ESRDgroup (2.67 % of cases) and 383 were from the HD ^−ESRDgroup (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 ^+ESRDpatients had no higher odds of ICH (adjusted odds ratio [AOR]: 0.91; 95 % confidence interval [CI]: 0.75–1.11) than did HD ^−ESRDpatients. In the subgroup analysis of immediate ICH, HD ^+ESRDpatients had lower odds than did HD ^−ESRDpatients (AOR: 0.73; 95 % CI: 0.56–0.94).

Conclusions

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

【 授权许可】

   
2015 Chen et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]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.
• [2]Kuo HW, Tsai SS, Tiao MM, Yang CY. Epidemiological features of CKD in Taiwan. Am J Kidney Dis. 2007; 49:46-55.
• [3]USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; 2005.
• [4]Khan F, Baguley IJ, Cameron ID. 4: Rehabilitation after traumatic brain injury. Med J Aust. 2003; 178:290-5.
• [5]Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008; 7:728-41.
• [6]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.
• [7]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.
• [8]Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013; 9:231-6.
• [9]Jagoda AS, Bazarian JJ, Bruns 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.
• [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.
• [11]Stiell IG, Laupacis A, Wells GA. Indications for computed tomography after minor head injury. Canadian CT Head and Cervical-Spine Study Group. N Engl J Med. 2000; 343:1570-1.
• [12]Cheng TM. Taiwan’s national health insurance system: high value for the dollar. In: Six Countries, Six Reform Models—the Healthcare Reform Experience of Israel, the Netherlands, New Zealand, Singapore, Switzerland and Taiwan. Okma KG, Crivelli L, editors. World Scientific, Hackensack, NJ; 2009: p.171-204.
• [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.
• [14]Nelson DL, Cox MM. Lehninger Pinciples of Biochemistry. hth ed. W. H. Freeman (Macmillan Education), New York; 2004.
• [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.
• [16]Sonawane S, Kasbekar N, Berns JS. The safety of heparins in end-stage renal disease. Semin Dial. 2006; 19:305-10.
• [17]Ouseph R, Ward RA. Anticoagulation for intermittent hemodialysis. Semin Dial. 2000; 13:181-7.
• [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.
• [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.
• [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.
• [21]Nawrocki J, Chrzanowski W, Koch D, Dziegielewski K. Vitreoretinal surgery in diabetic patients on hemodialysis. Eur J Ophthalmol. 1997; 7:283-7.
• [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.
• [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.
• [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.
• [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.
• [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.
• [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.
• [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.