High but stable incidence of subdural haematoma in haemodialysis--a single-centre study

BACKGROUND: The incidence of subdural haematoma (SDH) is high in haemodialysis (HD), with data suggesting an increasing incidence over time. The prognosis remains poor with 40% mortality at 30 days. The extent of this problem in non-US populations has not been described in the literature.

METHODS: We conducted a retrospective, single-centre UK study of non-traumatic SDH in patients established on maintenance HD between 1 January 2002 and 1 June 2009.

RESULTS: The prevalence of SDH was 0.4% at our centre with an overall annual incidence of 189 per 100 000 patients. SDH was associated with increased patient age (mean 71.3 +/- 8.5 years) but not associated with a higher prevalence of major comorbid conditions and antiplatelet or anticoagulant use. Mortality was high (46% at 30 days, 58% at 1 year). We did not observe a trend to increasing prevalence of this condition over time. Conclusions. SDH has a higher (>20 times) incidence in HD patients than in the general population and is associated with high mortality. Although the prevalence in this study was lower than in published US studies, the incidence rate is similar. Further studies to validate prognostic criteria that guide decisions regarding surgery are required.