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Comparative Study
. 2015 Jun 5;10(6):994-1001.
doi: 10.2215/CJN.08140814. Epub 2015 Mar 30.

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

I-Kuan Wang  1 , Yu-Kai Cheng  2 , Cheng-Li Lin  3 , Chiao-Ling Peng  4 , Che-Yi Chou  5 , Chiz-Tzung Chang  5 , Tzung-Hai Yen  6 , Chiu-Ching Huang  5 , Fung-Chang Sung  7 , Chung Y Hsu  8
Affiliations
Comparative Study

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

I-Kuan Wang et al. Clin J Am Soc Nephrol. .

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 (34.7 [95% CI, 31.4 to 35.4] versus 21.5 [95% CI, 20.2 to 22.9] per 10,000 person-years, with an adjusted hazard ratio of 1.62 [95% CI, 1.17 to 2.33]). Approximately 152 of 253 (60%) of SDH events were associated with trauma. Subsequent 30-day SDH-related mortality was not statistically higher in HD patients than in PD patients (29.1% versus 25.3%; adjusted odds ratio, 1.30; 95% CI, 0.70 to 2.41).

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.

Keywords: ESRD; hemodialysis; mortality; peritoneal dialysis; subdural hematoma.

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Figures

Figure 1.
Figure 1.
Flow chart of study cohort selection. HD, hemodialysis; ICD-9-CM, International Classification of Diseases Ninth Revision, Clinical Modification; PD, peritoneal dialysis; SDH, subdural hematoma.
Figure 2.
Figure 2.
The annual age-standardized incidence rates and 95% CIs of SDH in patients with ESRD receiving HD or PD from 1998 to 2010. 95% CI, 95% confidence interval; SDH, subdural hematoma.
Figure 3.
Figure 3.
The HR of SDH (HD versus PD) by sex, age, comorbidity, and medication. HR, hazard ratio; 95% CI, 95% confidence interval; CAD, coronary artery disease; CHF, congestive heart failure; AF, atrial fibrillation; HR, hazard ratio; SDH, subdural hematoma; HD, hemodialysis; PD, peritoneal dialysis.
Figure 4.
Figure 4.
The proportion of patients with ESRD receiving HD or PD who were free of SDH. HD, hazard ratio; SDH, subdural hematoma; PD, peritoneal dialysis.
See this image and copyright information in PMC

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