Impact of Dialysis Timing on Post-Surgery Outcomes in Brain Injury Patients

Dialysis patients

A friend underwent brain surgery due to a fall that caused intracranial hemorrhage.
The surgery was performed on the same day as dialysis, and later that evening, there was a need for an emergency surgery due to recurrent intracranial bleeding.
Is there a connection between the dialysis performed that day (the dialysis nurse mentioned that no anticoagulants were used) and the need for the second surgery? Would it have been more appropriate to perform dialysis the following day? The nephrologist stated that dialysis was necessary to reduce toxins, which could help lower intracranial pressure.

A-Hua, 30~39 year old female. Ask Date: 2011/06/22

Dr. Wang Weijie reply Internal Medicine

Dear Ah Hua,
Hello, the normal surgical procedure involves dialysis the day before the surgery and again the day after the surgery.
In case of an emergency, consultation with both the surgical and nephrology specialists is necessary.
According to the latest international guidelines, continuous renal replacement therapy is more suitable for patients with acute brain injury.
Wishing you safety and health.
Sincerely,
Dr.
Wang Wei-Jie
Director of Nephrology, Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2011/06/22

More Info

The timing of dialysis in patients who have undergone brain surgery, particularly after an event such as intracranial hemorrhage, is a critical consideration that can significantly impact postoperative outcomes. In your friend's case, where he underwent surgery for a brain injury due to a fall, the decision to initiate dialysis on the same day as the surgery raises several important points for discussion.

Firstly, it is essential to understand the role of dialysis in managing patients with acute kidney injury (AKI) or chronic kidney disease (CKD) who may require renal replacement therapy. Dialysis serves to remove toxins, excess fluids, and electrolytes from the blood, which can be particularly important in the context of brain injury where cerebral edema and increased intracranial pressure (ICP) are concerns. The removal of these toxins can indeed help in reducing ICP, which is crucial for brain recovery.

However, the timing of dialysis in relation to surgical procedures, especially in the context of brain surgery, must be approached with caution. Dialysis can lead to fluctuations in blood pressure and electrolyte imbalances, which may complicate the postoperative course. In your friend's case, the fact that he underwent dialysis on the same day as his brain surgery could have contributed to the need for a second emergency surgery later that evening, especially if there were any complications related to fluid shifts or blood pressure changes.

Moreover, the use of anticoagulants during dialysis is another critical factor. While the dialysis staff indicated that no anticoagulants were used, it is important to consider that anticoagulation is often necessary to prevent clotting within the dialysis circuit. However, in patients with recent brain surgery, the use of anticoagulants must be carefully weighed against the risk of bleeding. If anticoagulants were not used, this could potentially lead to clotting issues, but it also minimizes the risk of exacerbating any bleeding complications from the brain surgery.

In general, the consensus in the medical community is that if dialysis is necessary, it should be performed with careful monitoring of the patient's hemodynamic status and neurological condition. Ideally, if a patient is stable and there is no immediate need for dialysis, it may be prudent to wait until the patient has recovered sufficiently from the surgery before initiating dialysis. This allows for better management of blood pressure and fluid status, reducing the risk of complications.

In conclusion, while dialysis is essential for managing toxins and fluid overload in patients with kidney issues, the timing of its initiation in relation to brain surgery is crucial. In your friend's case, the decision to perform dialysis on the same day as the surgery may have contributed to his postoperative complications. It is advisable to have a multidisciplinary approach involving nephrologists, neurologists, and neurosurgeons to determine the optimal timing for dialysis in such complex cases. Continuous monitoring and individualized patient care are key to improving outcomes in patients recovering from brain injuries.

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