Outcome of aneurysmal subarachnoid haemorrhage in patients on maintenance haemodialysis

To investigate the outcome of aneurysmal subarachnoid haemorrhage (SAH) in patients on maintenance haemodialysis (HD), eight patients on maintenance HD and 245 patients not on HD who suffered from SAH, all of whom were surgically treated at our institution between 1993 and 1997, were reviewed. The clinical features and 3-month outcome of SAH were analysed in the eight HD patients (three males, five females) and compared with those in the 245 non-HD patients (77 males, 168 females). Although there were no significant differences in the patient's age, gender and pre-operative grading of SAH with the Hunt and Hess grading scale, the mortality rate in HD patients was significantly higher than that in non-HD patients (50% [4/8] vs 13% [32/245]; P<0.01), It was concluded that the outcome of aneurysmal SAH in HD patients was extremely poor. The explanation for the worse prognosis in HD patients seems not to lie in systemic heparization but in a vulnerability to SAH, because SAH in all HD patients occurred after anticoagulant activity from the previous dialysis had already disappeared.