Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury.
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(+ESRD) patients after HI.


METHODS
In this nationwide population-based study using Taiwan's National Health Insurance Research Database, we enrolled 6938 HD(+ESRD) HI patients for the case group and 13,876 randomly selected HD(-ESRD) HI patients for the control group. Measures of the post-HI association between HD(+ESRD) and ICH determined using conditional logistic regression.


RESULTS
Five hundred sixty-eight (2.74 %) patients had post-HI ICH: 185 in the HD(+ESRD) group (2.67 % of cases) and 383 were from the HD(-ESRD) group (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(+ESRD) patients had no higher odds of ICH (adjusted odds ratio [AOR]: 0.91; 95 % confidence interval [CI]: 0.75-1.11) than did HD(-ESRD) patients. In the subgroup analysis of immediate ICH, HD(+ESRD) patients had lower odds than did HD(-ESRD) patients (AOR: 0.73; 95 % CI: 0.56-0.94).


CONCLUSIONS
HD(+ESRD) did not increase the post-HI risk of ICH. Therefore, it may not be necessary to lower the threshold of head CT in HD(+ESRD) patients.
Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
Hsin-Hung
HH
Chen
Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Chien-Chin
CC
Hsu
Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
Shih-Feng
SF
Weng
Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.|Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
Hung-Jung
HJ
Lin
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
Jhi-Joung
JJ
Wang
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
How-Ran
HR
Guo
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 Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
Shih-Bin
SB
Su
Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.
Chien-Cheng
CC
Huang
Department of Emergency Medicine, Cathay General Hospital, No. 280, Sec. 4, Ren'ai Road, Da'an District, Taipei City, 106, Taiwan. chenjiannhwa@yahoo.com.tw.|Fu Jen Catholic University School of Medicine, Taipei, Taiwan. chenjiannhwa@yahoo.com.tw.
Jiann-Hwa
JH
Chen
D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D013624:Taiwan; D014057:Tomography, X-Ray Computed