Clinical features and management of intracranial hemorrhage in patients undergoing maintenance dialysis therapy

The management and outcome were retrospectively investigated in patients with chronic renal failure receiving maintenance blood purification who suffered intracranial hemorrhage. Patients with intracerebral hemorrhage (ICH, n = 36) or subarachnoid hemorrhage (SAH, n = 5) were evaluated. Both groups were initially managed using continuous hemofiltration (HF) after admission, except for two patients with SAH receiving maintenance peritoneal dialysis. Patients with ICH were managed with HF three times a week after computed tomography showed decreased peripheral edema. Nafamostat mesilate was used as the anticoagulant for both continuous HF and HF. Hemodialysis (HD) three times a week was initiated after confirming the absence of neurological deterioration using HF. Craniotomy was not performed in any patient with ICH, but if necessary, the hematoma was aspirated using burr-hole surgery. Angiography was performed on the day of admission in patients with SAH. Delayed neck-clipping surgery was performed after continuous HF for 2 weeks with lumbar cerebrospinal fluid drainage. In patients with ICH, continuous HF was continued for 2-9 days after admission (mean 5.2 +/- 2.2 days), followed by 2-9 courses of HF (mean 4.7 +/- 2.1 courses). HD was initiated 9-26 days after admission (mean 15.5 +/- 4.6 days). Favorable outcomes were achieved by 13 of the 36 patients with ICH and two of the five patients with SAH, whereas 22 patients with ICH and three patients with SAH died. Death occurred in 12 of 16 patients with ICH and diabetic nephropathy. In contrast, 10 of 20 non-diabetic patients with ICH had favorable outcomes. Ten of the 16 patients with initial GCS < or = 8 and six of the 20 with GCS > or = 9 were diabetic. Therefore, there were significant differences between diabetic and non-diabetic patients (p = 0.05). Poor outcomes in diabetic patients with ICH are caused by primary brain damage, reflected in the initial disturbance of consciousness.