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Dialysis-associated seizures in children and adolescents
C M Glenn1, S J Astley, S L Watkins
1Division of Nephrology, Children's Hospital and Medical Center, Seattle, WA 98105.
Insights
Children undergoing hemodialysis (HD) face a higher risk of dialysis-associated seizures (DAS) compared to those on peritoneal dialysis (PD). A history of seizures significantly increases this risk in HD patients, necessitating close monitoring.
Area of Science:
- Pediatric Nephrology
- Neurology
- Critical Care Medicine
Background:
- Seizures are a potential complication in children and adolescents undergoing renal replacement therapy.
- Understanding risk factors for dialysis-associated seizures (DAS) is crucial for patient safety.
Purpose of the Study:
- To identify risk factors for seizure occurrence during or within 24 hours of hemodialysis (HD) and peritoneal dialysis (PD) in pediatric patients.
- To compare the incidence of DAS between HD and PD modalities.
Main Methods:
- Retrospective medical chart review of 180 pediatric patients (newborn to 22 years) treated between 1974 and 1988.
- Analysis of seizure occurrence in relation to HD, PD, and prior seizure history.
Main Results:
- Dialysis-associated seizures (DAS) occurred in 7.2% of patients; 12 during HD and 1 during PD.
- Patients on HD had a significantly higher risk of DAS (9%) than those on PD (0%).
- A prior history of seizures was a significant risk factor for DAS in HD patients (29% vs. 8%).
Conclusions:
- Hemodialysis is associated with a higher risk of seizures in pediatric patients compared to peritoneal dialysis.
- Pediatric patients receiving HD, particularly those with a history of seizures, require close monitoring during and after dialysis.
- Proactive measures to mitigate seizure risk should be implemented for high-risk HD patients.
Abstract:
A retrospective medical chart review was conducted to document seizure occurrence in 180 children and adolescents (newborn to 22 years of age) receiving hemodialysis (HD) and/or peritoneal dialysis (PD) from January 1974 through June 1988 at Children's Hospital and Medical Center in Seattle, Washington. The purpose of the review was to identify risk factors associated with seizure activity during or up to 24 h following dialysis treatment. Seventy-eight patients received only HD, 79 received only PD and 23 received both HD and PD. Dialysis-associated seizures (DAS) were seen in 7.2% (13/180) of all dialyzed patients; 12 occurred during HD and 1 occurred during PD. Patients receiving only HD were more likely to experience DAS (7/78, 9%), than patients receiving only PD (0/79, 0%) (chi-squared = 5.5, 1 df, P = 0.02). Among the 101 patients who received HD, the risk of HD-associated seizures among those with a prior history of seizure (6/21, 29%) was significantly higher than among those with no history of seizure (6/80, 8%) (chi-squared = 5.2, 1 df, P = 0.02). Prior history of seizure did not influence the risk of seizures among patients receiving PD. These data suggest that patients receiving HD, and especially those with a prior history of seizure, should be monitored closely during dialysis and measures taken to reduce the risk of seizures.