Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

Hsieh, Cheng Yang; Chen, Chih‐Hung; Wu, An‐Bang; Tseng, Chin Chung

doi:10.1159/000312228

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…Before patients were enrolled, they received CVVH, which is generally thought to be optimal to maintain brain hemodynamics. 13 All patients were ventilated in controlledvolume mode in the supine position. After the patients recovered from acute brain hemorrhage presenting with stable hemodynamics with acceptable ICP of less than 20 mm Hg, 3 they were randomized to receive CVVH or SLED on the 1st day and began the other modality on the 2nd day.…”

Section: Methodsmentioning

confidence: 99%

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

Wu¹,

Huang²,

Shiao

et al. 2013

JNS

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Object Hemodynamic instability occurs frequently during dialysis treatment and remains a significant cause of patient morbidity and mortality, especially in patients with brain hemorrhage. This study aims to compare the effects of hemodynamic parameters and intracranial pressure (ICP) between sustained low-efficiency dialysis (SLED) and continuous veno-venous hemofiltration (CVVH) in dialysis patients with brain hemorrhage. Methods End-stage renal disease (ESRD) patients with brain hemorrhage undergoing ICP monitoring were enrolled. Patients were randomized to receive CVVH or SLED on the 1st day and were changed to the other modality on the 2nd day. The ultrafiltration rate was set at between 1.0 kg/8 hrs and 1.5 kg/8 hrs according to the patient's fluid status. The primary study end point was the change in hemodynamics and ICP during the dialytic periods. The secondary end point was the difference between cardiovascular peptides and oxidative and inflammatory assays. Results Ten patients (6 women; mean age 59.9 ± 3.6 years) were analyzed. The stroke volume variation was higher with SLED than CVVH (generalized estimating equations method, p = 0.031). The ICP level increased after both SLED and CVVH (time effect, p = 0.003) without significant difference between modalities. The dialysis dose quantification after 8-hour dialysis was higher in SLED than CVVH (equivalent urea clearance by convection, 62.7 ± 4.4 vs 50.2 ± 3.9 ml/min; p = 0.002). Additionally, the endothelin-1 level increased after CVVH treatment (p = 0.019) but not SLED therapy. Conclusions With this controlled crossover study, the authors provide the pilot evidence that both SLED and CVVH display identical acute hemodynamic effects and increased ICP after dialysis in brain hemorrhage patients. Clinical trial registration no.: NCT01781585 (ClinicalTrials.gov).

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Section: Methodsmentioning

confidence: 99%

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

Wu¹,

Huang²,

Shiao

et al. 2013

JNS

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“…As the severity of the intracranial hemorrhage predominantly determines outcome, survival has been reported to be similar for peritoneal and hemodialysis patients . However, for patients with raised intracranial pressure (ICP), and in particular those who increase their ICP during hemodialysis, have been reported to have around 80% mortality, predominantly due to brain coning …”

Section: Risk Factors For Survivalmentioning

confidence: 99%

“…Hemodialysis treatments can potentially exacerbate brain injury by both causing an increase in brain water content and ICP, and also by excessive ultrafiltration leading to reduced cerebral perfusion …”

Section: General Principles Of Hemodialysis For the Conscious Chronicmentioning

confidence: 99%

Changing the hemodialysis prescription for hemodialysis patients with subdural and intracranial hemorrhage

Davenport

2013

Hemodialysis International

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Although continuous modalities of renal replacement therapy offer an advantage to the patient with compromised cerebral perfusion and intracranial hypertension, they are generally limited to the intensive care unit setting. Many hemodialysis patients admitted with strokes and subdural hematoma are managed on general wards. As such, these patients are generally treated by intermittent hemodialysis, and their dialysis prescription should be altered to minimize changes in serum osmolality, and fall in blood pressure during dialysis. Such patients require more frequent but shorter dialysis sessions, using minimally bioincompatible small surface area dialyzers with lower blood flows, in combination with higher sodium and cooled dialysate. In patients at risk of intracranial hemorrhage and those with invasive intracranial monitoring, systemic anticoagulants should be avoided, choosing no anticoagulation protocols or regional anticoagulants.

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Renal Replacement Therapy and Dialysis-associated Neurovascular Injury (DANI) in the Neuro ICU: a Review of Pathophysiology and Preventative Options

Ghoshal

Freedman

2021

Curr Treat Options Neurol

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Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

Cited by 6 publications

References 40 publications

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

Changing the hemodialysis prescription for hemodialysis patients with subdural and intracranial hemorrhage

Renal Replacement Therapy and Dialysis-associated Neurovascular Injury (DANI) in the Neuro ICU: a Review of Pathophysiology and Preventative Options

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