NON-TRAUMATIC SUBDURAL HEMATOMA IN PATIENTS ON HEMODIALYSIS WITH END-STAGE KIDNEY DISEASE

Abstract

Background: Subdural hematoma (SDH) is most commonly associated with head trauma, but nontraumatic SDH has become more prevalent in patients undergoing long-term hemodialysis for ESKD. These patients are at higher risk due to coagulopathies associated with renal failure, as well as the frequent use of anticoagulants in their dialysis regimen. Understanding the risk factors and appropriate management is critical to improving patient outcomes.

Aim: To assess the incidence, risk factors, and clinical outcomes of nontraumatic subdural hematoma in patients with end-stage kidney disease on hemodialysis.

Methods: A profile of 40 patients was available in this Retrospective-Prospective study conducted in the Department of Neurosurgeryat super Speciality Hospital,   one of the associated Hospitals of Government Medical College Srinagar. Eligible patients with nontraumatic subdural hematoma with end-stage kidney disease on hemodialysis during study period were analysed either conservatively or need for surgery. The neurosurgical procedures included procedures of unilateral or bilateral burr hole drainage, craniotomy, and craniectomy.   Laboratory Investigations (including CBC, KFT, LFT, coagulogram, serum electrolytes, blood grouping) required for preoperative evaluation were done.

Results: The study included 40 patients, with 65% being male and an average age of 59 years. Anticoagulation therapy was administered to 80% of the patients, and a significant correlation was found between anticoagulation use and larger subdural hematomas (average volume of 35 cm², p < 0.01). Average volume of SDH was 35±2.5 cm square among the study population.   Hypertension was present in 85% of patients, with an overall mortality rate of 20%. Of these, 4 patients died during dialysis sessions before surgery, and 4 patients died post-surgery. Surgery was performed on 25 patients (62.5%).

Conclusion: This study underscores the need for heightened awareness and early intervention to manage the bleeding risks associated with hemodialysis, particularly in patients with a history of hypertension and those on long-term anticoagulation therapy.