Nontraumatic subdural hematoma in patients on hemodialysis with end-stage kidney disease: a systematic review and pooled analysis

Frontiers in Neurology

Neurology

Xiaoyu Dai¹  Liling Yang¹  Lijun Wang¹  Xiaoyi Wang²  Zongping Li²  Hongyuan Liu² 

[1] Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China;Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China;

关键词: end-stage kidney disease;    nontraumatic subdural hematoma;    hemodialysis;    kidney failure;    kidney replacement therapy;   

DOI  :  10.3389/fneur.2023.1251652

 received in 2023-07-02, accepted in 2023-09-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe 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.MethodsElectronic 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.ResultsA 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.ConclusionNSDH 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).

【 授权许可】

Unknown   
Copyright © 2023 Yang, Li, Dai, Wang, Wang and Liu.