Interventions for preventing haemodialysis dysequilibrium syndrome.

Area of Science:

• Nephrology
• Neurology
• Clinical Trials

Background:

• Dialysis dysequilibrium syndrome (DDS) presents as neurological symptoms during or after initiating haemodialysis (HD), linked to significant morbidity and mortality.
• Preventing DDS is crucial for patient safety during HD initiation or reinitiation.

Purpose of the Study:

• To evaluate the efficacy and safety of interventions designed to prevent Dialysis dysequilibrium syndrome (DDS).
• To assess the benefits and harms of different strategies for DDS prevention in haemodialysis patients.

Main Methods:

• Conducted a systematic review of randomised controlled trials (RCTs) comparing interventions against standard care for DDS prevention.
• Searched major databases including CENTRAL, MEDLINE, and EMBASE up to May 2024.
• Assessed study quality using Cochrane Risk of Bias 2 and evidence certainty using GRADE.

Main Results:

• Two RCTs with 32 participants compared slow dialysis, sodium modeling, standard, and high sodium dialysate.
• Slow dialysis versus sodium modeling showed little to no difference in DDS, severe DDS, and death (low certainty evidence).
• Standard versus high sodium dialysate had uncertain effects on DDS incidence, severe DDS, and adverse events (very low certainty evidence).

Conclusions:

• Current evidence suggests uncertain benefits of sodium modeling and slow dialysis for preventing DDS and death in HD patients.
• The effects of standard and high sodium dialysate on DDS, death, and adverse events remain highly uncertain.
• Further high-quality RCTs are needed to establish effective DDS prevention strategies.