Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring

Esnault, Pierre; Lacroix, Guillaume; Cungi, Pierre-Julien; D'Aranda, Erwan; Cotté, Jean; Goutorbe, Philippe

doi:10.1186/cc11877

Cited by 24 publications

(17 citation statements)

References 3 publications

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“…Both a high BUN level (.175 mg/dl) and its rapid decline are risk factors for DDS (7,18,19). Additional risk factors include preexisting neurologic conditions, the first session of HD, hyponatremia, and liver disease (7,18,20). It is unknown whether the risk of DDS is similar in patients with advanced CKD and those with AKI.…”

Section: Dialysis Disequilibrium Syndromementioning

confidence: 99%

“…Thus, a short HD session (2 hours) with a low blood flow (200 ml/min) and a urea reduction ratio goal of 0.4 is recommended as the initial prescription for patients at risk for DDS (7,17). Continuous RRT (CRRT) may be considered in patients at high risk for DDS, including those with intracranial mass or brain injury (20). Kidney Disease Improving Global Outcomes recommends CRRT over intermittent dialysis for AKI in patients with brain injury/edema or elevated intracranial pressure (21).…”

Section: Dialysis Disequilibrium Syndromementioning

confidence: 99%

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Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

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Section: Dialysis Disequilibrium Syndromementioning

confidence: 99%

Section: Dialysis Disequilibrium Syndromementioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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“…In addition, we assumed, based on our patient's clinical status (being asymptomatic between HD sessions) and radiological investigations, that her VP shunt was fully functional. The aforementioned group used ICP monitoring to guide therapy during haemodialysis in a post-traumatic brain-injured patient in an intensive care unit (ICU) setting 4. However, this was neither necessary nor feasible in our case, since our patient was otherwise well, and probably suffering from the early features of DDS.…”

Section: Discussionmentioning

confidence: 93%

Headache during haemodialysis in a patient with shunt: a cause for concern?

O'Sullivan¹,

Sajjad

Abrar

et al. 2015

BMJ Case Reports

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SUMMARYA 20-year-old woman with a functioning ventriculoperitoneal (VP) shunt consistently reported unbearable vertex headaches and nausea during the last hour of her haemodialysis (HD) sessions. After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. She improved fully on cessation of HD, requiring simple analgaesia only, and continued dialysis three times per week. Several more distressing episodes of nausea and headaches compelled us to give intravenous mannitol during HD, resulting in temporary improvement. Subsequently, shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response. BACKGROUND

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“…Other clinical risk factors for DDS are starting HD for the first time, severe uremia, an older or younger age (e.g., elderly or children), pre-existing neurological disorders, and severe metabolic acidosis [8,9]. In addition, patients with pre-existing conditions predisposed to brain edema (sepsis, hypercapnia, malignant hypertension, hyponatremia, hypoglycemia, and hepatic encephalopathy) are much more susceptible to DDS than those without such conditions.…”

Section: Discussionmentioning

confidence: 99%

“…The mean ICP starts to increase after the first hour of HD and remains high during HD. The ICP increase during HD initiation is measured directly in some acute or chronic renal failure patients with intracranial hemorrhaging or head trauma who undergo craniectomy or craniotomy [9,[11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

A case report with a literature review: cerebral meningioma diagnosed by convulsion and consciousness disorder on initiating hemodialysis

et al. 2020

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Background: Neurological symptoms sometimes occur in hemodialysis patients, with causes including cerebral infarction, cerebral hemorrhaging, meningitis, and encephalitis. Dialysis disequilibrium syndrome (DDS) is widely known as a complication of hemodialysis and is typically encountered in severe uremic patients newly started on hemodialysis. The pathogenesis of DDS is thought to be brain edema that manifests as neurological symptoms, including headache, nausea, confusion, seizures, and coma. However, the relationship between brain tumors and neurological manifestations during hemodialysis is poorly understood. Case presentation: The patient was a 55-year-old man with severe renal dysfunction and uremia symptoms. Blood chemistry showed severe azotemia and acidosis. The patient was placed on short-duration hemodialysis (2 h) with a relatively small surface area, low blood flow (100 mL/min), and intradialytic glycerol infusion to prevent DDS. However, after his first hemodialysis treatment, he complained of disturbed consciousness. We diagnosed his neurological condition as DDS and observed the progress carefully. The next morning, his symptoms had completely resolved, so the patient was started on his second hemodialysis session with the same conditions. However, 2 h after starting the second hemodialysis session, he suffered convulsions accompanied by impaired consciousness. Brain computed tomography (CT) revealed a convexity meningioma and cerebral edema with a midline shift. Before starting the hemodialysis, he had shown no history of seizures, morning headache, or other neurological symptoms. In this case, meningioma was diagnosed based on an increase in the intracranial pressure which occurred after the initiation of hemodialysis. Conclusion: We report this suggestive case to prompt physicians to consider the potential effect of hemodialysis introduction on the brain pressure.

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Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring

Cited by 24 publications

References 3 publications

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Headache during haemodialysis in a patient with shunt: a cause for concern?

A case report with a literature review: cerebral meningioma diagnosed by convulsion and consciousness disorder on initiating hemodialysis

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