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Unexpected seizures during hemodialysis. Effect of dialysate prescription
D M Ford1, R J Portman, D L Hurst
1Department of Pediatrics, University of Colorado Medical School, Denver 80262.
Insights
Bicarbonate hemodialysis (HD) may improve neurological stability in children, especially those with seizure disorders. Continuous electroencephalogram monitoring (CEM) is a valuable tool for assessing neurological stability during HD.
Area of Science:
- Pediatric Nephrology
- Neurology
- Clinical Chemistry
Background:
- Chronic hemodialysis (HD) in children can impact neurological stability.
- Dialysate composition is a key factor in managing HD complications.
- Assessing intradialytic neurological function is crucial for patient care.
Purpose of the Study:
- To evaluate the impact of different dialysate prescriptions on intradialytic neurological stability in pediatric HD patients.
- To compare the effects of low sodium acetate, high sodium acetate, and low sodium bicarbonate dialysates.
- To determine the utility of continuous electroencephalogram monitoring (CEM) in assessing neurological stability during HD.
Main Methods:
- Continuous electroencephalogram monitoring (CEM) was used in five children undergoing chronic HD.
- Patients were monitored before, during, and after HD sessions using three different dialysate prescriptions: low sodium acetate (LAc), high sodium acetate (HAc), and low sodium bicarbonate (LBi).
- Neurological stability and symptoms of disequilibrium were assessed.
Main Results:
- Three children, including those with seizure disorders, showed subclinical seizures on LAc and HAc but improved neurological stability on LBi.
- CEM studies remained unchanged in two children across all regimens.
- Symptoms of disequilibrium were most frequent with LAc (4/5 children) and least frequent with LBi (1/5 children).
Conclusions:
- Bicarbonate-based hemodialysis (LBi) may enhance intradialytic neurological stability in children, particularly those with seizure disorders.
- CEM is an effective tool for evaluating intradialytic neurological stability in pediatric HD patients.
- Dialysate composition significantly influences neurological outcomes during pediatric hemodialysis.
Abstract:
To assess the effects of the dialysate prescription on the intradialytic neurological stability of children requiring chronic hemodialysis (HD), continuous EEG monitoring (CEM) was performed on five children before, during and after HD against: (1) low sodium acetate (LAc: Na 132 mEq/l, acetate 38 mEq/l); (2) high sodium acetate (HAc: Na 144 mEq/l, acetate 41 mEq/l), and (3) low sodium bicarbonate (LBi: Na 133 mEq/l, bicarbonate 35 mEq/l) dialysate. Three children, two with clinically well-controlled seizure disorders and one with no seizure history, exhibited subclinical seizures on LAc and HAc but improved neurological stability on LBi. Two children had essentially unchanged CEM studies on any HD regimen. Symptoms of disequilibrium were noted in four of the five children on LAc, two of the five on HAc and only one of the five on LBi. The data suggest that bicarbonate HD may enhance intradialytic neurological stability, particularly in children with known seizure disorders. Furthermore, CEM was found to be a useful tool for evaluating the neurological stability of children during HD.