Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

Abstract

Background and objectives This study compared the risk of subdural hematoma (SDH) and subsequent mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients with ESRD.Design, setting, participants, & measurements Claims data were obtained from the National Health Insurance Administration Research Database in Taiwan. This retrospective cohort study comprised 10,136 PD patients and 10,136 HD patients with newly diagnosed ESRD from 1998 to 2010. Patients were matched by propensity score and year of dialysis initiation. Incidence rates and hazard ratios of SDH as well as odds ratios of subsequent 30-day deaths from SDH were evaluated from the date of the first dialysis session to the date when SDH was diagnosed, or the date of renal transplantation, death, withdraw from insurance, or the end of the follow-up period (December 31, 2011).Results Median (25th percentile, 75th percentile) follow-up times for SDH events were 3.61 years (1.91, 6.33) and 3.33 years (1.83, 5.66) in the HD and PD cohorts, respectively. The overall SDH incidence rate (95% confidence interval [95% CI]) was 61.4% higher in the HD cohort than in the PD cohort (34. Conclusions HD patients have a higher risk of developing SDH than PD patients. Both patient groups have a high risk of mortality. Routine education on fall prevention is needed for dialysis patients.

Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis

“…12 13 It is well known that dialysis patients have higher risks of bleeding. [14][15][16] The rate of major bleeding when treated with warfarin raises 10-fold according to the Dialysis Outcomes and Practice Patterns Study. 17 Besides the risk of bleeding, some evidence suggests that warfarin might be associated with an increased risk of calciphylaxis 18 19 and accelerated vascular calcification in dialysis patients.…”

“…Results are summarised (eTables [14][15][16]. The 'leave one out' analyses were performed (eTable 17).…”

“…13 It is well known that dialysis patients have higher risks of bleeding 14–16. The rate of major bleeding when treated with warfarin raises 10-fold according to the Dialysis Outcomes and Practice Patterns Study 17.…”

Mortality in the Elderly on Dialysis

“…A recently published retrospective analysis of 121,623 patients on incident dialysis suggests that the risk of incident dementia is lower with PD compared with HD (HR, 0.46; 95% CI, 0.41 to 0.53) (21). There also seems to be a higher risk of subdural hematomas in patients on HD compared with those on PD (HR, 1.62; 95% CI, 1.17 to 2.33) (22). This is particularly important for a population at high risk of falls.…”

The comparison of risk of stroke in patients with peritoneal dialysis and hemodialysis: A systematic review and meta‐analysis

“…It is unclear whether the choice of dialysis modality affects the risk of stroke . Each renal replacement modality causes physiological changes that may affect the risk of stroke in a different way .…”