Abstract
We report the successful use of stepwise renal-relcement therapy for conservative management of a regular hemodialysis patient with intracranial hemorrhage. The patient was an 84-year-old man who consulted the emergency room of our hospital complaining of vertigo and nausea. He had been on regular hemodialysis for chronic renal failure due to nephrosclerosis for two years. Brain CT demonstrated left intracerebellar hemorrhage. Upon admission to the Department of Neurosurgery, we started continuous automated peritoneal dialysis to avoid increased intracranial pressure and enlargement of bleeding. After the patient's physical and radiographic findings improved, we proceeded with hemofiltration, then hemodifiltration, then hemodialysis. Our patient responded well to this stepwise renal-relacement therapy.
Considering the management of chronic hemodialysis patients with intracranial hemorrhage, two critical problems must be addressed. One is increased intracranial pressure that results from rapid decrease in serum osmolarity. The other is the risk of enlargement of intracranial hemorrhage due to systemic heparinization during hemodialysis. In conclusion, stepwise renal-replacement therapy is promising and should be considered in the management of hemodialysis patients with intracranial hemorrhage.
