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 】

Figure 6.

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