Retrospective analysis of nontraumatic subdural hematoma incidence and outcomes in Egyptian patients with end-stage renal disease on hemodialysis

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Fayed A.; Tarek A.; Refaat M.I.; Abouzeid S.; Salim S.A.; Zsom L.; Fülöp T.; Soliman K.M.; Elmallawany M.A.

Journal: Renal Failure

Publisher: Taylor and Francis Ltd.

Publication Date: 22 September 2021

Volume / Issue: Volume 43 / Issue 1

Pages: 1322–1328

ISSN: 0886022X

DOI: 10.1080/0886022X.2021.1979038

Scopus: View on Scopus

PubMed: 34547969

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Fayed A., Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Tarek A., Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Refaat M.I., Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Abouzeid S., Nephrology Department, Theodor Bilharz Research Institute, Cairo, Egypt; Salim S.A., Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, United States; Zsom L., Fresenius Medical Care Hungary, Cegléd, Hungary; Fülöp T., Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, United States, Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States; Soliman K.M., Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, United States, Department of Surgery, Transplant Nephrology, Medical University of South Carolina, Charleston, SC, United States; Elmallawany M.A., Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt

Abstract

Background: The incidence of subdural hematoma (SDH) in chronic maintenance hemodialysis (CMH) patients may change over time, along with the evolving characteristics of the underlying populations. Methods: We conducted a retrospective, single-center study at Cairo University hospitals, assessing the incidence, associated risk factors, and outcomes of nontraumatic SDH in CMH patients between January 2006 and January 2019. Results: Out of 1217 CMH patients, nontraumatic SDH was diagnosed in 41 (3.37%) during the study, increasing with the enrollees’ age but stable over the observation period and translating into an annual incidence rate of 28 per 1000 patients per year. SDH patients were likely to use central venous catheters, reported pruritis and history of bone fractures, and had higher phosphorus, parathyroid hormone, and alkaline phosphatase values (p < 0.001); however, there was no association with atrial fibrillation or use of anticoagulants. In the SDH cohort (n = 41), six patients did not need surgical intervention and 13 patients died before becoming surgically fit for intervention; mortality correlated with ischemic heart disease (p = 0.033) and the presence of atrial fibrillation or chronic anticoagulation with warfarin (p < 0.0001 for both), among others. Twenty-two patients received surgical operations and of these 2 died postoperatively; overall patient mortality was 12/41 (29.27%) at 30 days and 15/41 (36.59%) at 1 year. Conclusion: Our study demonstrated a striking enrichment for underlying comorbidities in those patients developing SDH and a high risk of immediate mortality. The benefit of chronic anticoagulation therapy should be carefully weighed against the risk of CNS bleed in MHD patients. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Keywords

Hemodialysis; mortality; nontraumatic subdural hematoma; outcome; Aged; Anticoagulants; Atrial Fibrillation; Egypt; Female; Hematoma, Subdural; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Risk Factors; acetylsalicylic acid; albumin; alkaline phosphatase; calcium; clopidogrel; ferritin; fibrinogen; hemoglobin; parathyroid hormone; phosphorus; uric acid; warfarin; anticoagulant agent; adult; age; albumin blood level; alkaline phosphatase blood level; anticoagulant therapy; Article; calcium blood level; clinical feature; clinical outcome; cohort analysis; comorbidity; controlled study; Egyptian; end stage renal disease; ferritin blood level; fibrinogen blood level; fracture; hemodialysis patient; hemoglobin blood level; human; maintenance therapy; major clinical study; medical history; observational study; parathyroid hormone blood level; phosphate blood level; platelet count; pruritus; retrospective study; risk factor; subdural hematoma; uric acid blood level; adverse event; chronic kidney failure

Citation Information

Scopus Citations: 5

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