Subdural hematoma in patients with end-stage renal disease receiving hemodialysis

Eur J Neurol. 2014 Jun;21(6):894-900. doi: 10.1111/ene.12406. Epub 2014 Apr 1.


Background and purpose: Hemodialysis (HD) may increase the risk of acute subdural hematoma (SDH) with high fatality, but the extent of this disease in non-western populations is unclear. The incidence of and fatality from SDH in patients with end-stage renal disease (ESRD) on HD were examined for an Asian population.

Methods: A cohort of 4709 newly diagnosed ESRD patients on HD from 1998 to 2010 and a control cohort of 18 663 subjects without any kidney disease were identified from a universal insurance claims database in Taiwan. The incidence and hazard of SDH for the two cohorts and 30-day mortality from SDH were measured by the end of 2010.

Results: The incidence of SDH was 4.47-fold higher in the HD cohort than in the control cohort (56.3 vs. 12.6 per 10 000 person-years) with an adjusted hazard ratio (HR) of 3.81 (95% CI 2.77-5.25). HD patients with SDH had a high odds of 30-day mortality with an adjusted odds ratio of 6.34 (95% CI 2.37-16.9).

Conclusions: ESRD patients with HD were demonstrated to be at high risk of subsequent SDH and to have a high mortality risk from SDH. Proper care for HD patients is necessary to prevent the devastating disorder.

Keywords: cohort study; end-stage renal disease; hemodialysis; subdural hematoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Female
  • Hematoma, Subdural / epidemiology*
  • Hematoma, Subdural / etiology*
  • Hematoma, Subdural / mortality
  • Humans
  • Incidence
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / mortality
  • Taiwan / epidemiology