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Dialysis Disequilibrium Syndrome Revisited
Mandeep M Sahani1, Tarek M Daoud1, Ramin Sam1
1Departments of Medicine: Veterans Affairs Hospital (Hines), Loyola University-Chicago (Chicago), Stritch School of Medicine (Maywood), Illinois, U.S.A.; Alice Ho Nethersole Hospital, Hong Kong, China.
Hemodialysis International. International Symposium on Home Hemodialysis
|April 29, 2017
Summary
Dialysis disequilibrium syndrome (DDS) can cause severe neurological symptoms in azotemic patients. Preventive strategies, including adjusting dialysis efficiency and osmolality, are crucial for patient safety.
Area of Science:
- Nephrology
- Neurology
- Critical Care Medicine
Background:
- Aggressive dialysis in azotemic patients, particularly with metabolic acidosis, risks Dialysis Disequilibrium Syndrome (DDS).
- DDS manifests with neurological symptoms ranging from mild nausea to severe seizures and coma.
- Cerebral edema, driven by the reverse urea effect, cerebrospinal fluid acidosis, or idiogenic osmoles, underlies DDS.
Purpose of the Study:
- To outline the mechanisms and clinical manifestations of Dialysis Disequilibrium Syndrome (DDS).
- To emphasize the importance of preventive measures for DDS in patients with severe uremia.
- To describe strategies for mitigating DDS during dialysis treatment.
Main Methods:
- Review of mechanisms causing cerebral edema during dialysis.
- Description of clinical presentations of Dialysis Disequilibrium Syndrome.
- Explanation of preventive strategies for Dialysis Disequilibrium Syndrome.
Main Results:
- Dialysis Disequilibrium Syndrome is caused by cerebral edema.
- Key mechanisms include the reverse urea effect, cerebrospinal fluid acidosis, and idiogenic osmoles.
- Preventive measures are vital for patients undergoing dialysis.
Conclusions:
- Dialysis Disequilibrium Syndrome presents a significant risk during aggressive dialysis for azotemic patients.
- Preventive strategies involve modulating dialysis efficiency and blood osmolality.
- Prompt intervention with anticonvulsants may be necessary if preventive measures fail.
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