Dialysis disequilibrium syndrome leading to sudden brain death in a chronic hemodialysis patient

Dalia, Tarun; Tuffaha, Ahmad

doi:10.1111/hdi.12635

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…The symptoms and signs of DDS (Table 1) are secondary to the development of cerebral edema and have a temporal relationship to the dialysis procedure. Neurologic manifestations progress sequentially as cerebral edema worsens and intracranial pressure rises, and if not promptly recognized and managed, can lead to coma and even death 2. The initial presentation of vomiting, headache, dizziness, agitation, disorientation, confusion, muscle cramps and tremors are common in chronic dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

“…They are usually ascribed to excessive or aggressive ultrafiltration, and hyper- or hypotension. However, DDS can occur in patients on chronic dialysis and must remain in the differential diagnosis, especially when predialysis blood urea nitrogen (BUN) is high and/or there is another driver for hyperosmolality, for example, hyperglycemia or hypernatremia 2. Studies measuring brain density in chronic dialysis patients using head computed tomography (CT) revealed decreased brain density or increased brain water during and after hemodialysis, but not in normal individuals or those on continuous peritoneal dialysis 3.…”

Section: Introductionmentioning

confidence: 99%

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<p>Dialysis disequilibrium syndrome prevention and management</p>

Mistry

2019

IJNRD

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The dialysis disequilibrium syndrome (DDS) is a clinical constellation of neurologic symptoms and signs occurring during or shortly following dialysis, especially when dialysis is first initiated. It is a diagnosis of exclusion occurring in those that are uremic and hyperosmolar, in whom rapid correction with renal replacement therapy leads to cerebral edema and raised intracranial pressure with resultant clinical neurologic manifestations. DDS is most commonly described in association with hemodialysis but can occur in patients with acute kidney injury requiring continuous renal replacement therapy (CRRT). To date, it has not been described in association with peritoneal dialysis. The syndrome is uncommon and becoming rarer, so performing randomized controlled trials to evaluate the effectiveness of potential therapies is almost impossible. This also makes studying the pathophysiology in humans challenging. It is associated with mortality but is also preventable, so identification of patients at risk, preventive measures, early recognition and prompt management of DDS will minimize morbidity and mortality associated with this syndrome. While the focus of this review is the prevention and management of DDS, there will be an emphasis on what is known about the pathophysiology because it strongly impacts the prevention and management strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Dialysis disequilibrium syndrome prevention and management</p>

Mistry

2019

IJNRD

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“…The prognosis of DDS yet remains unclear. Many fatal cases of DDS have been previously reported [ 2 , 14 - 17 ]. However, some patients have fully recovered from DDS, like our patient [ 18 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mild symptoms include fatigue, headache, nausea, vomiting, muscle cramps, and tremors. However, it can also result in coma, seizures, and even death in severe cases [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Dialysis Disequilibrium Syndrome in a Patient With Acute Kidney Injury on Chronic Kidney Disease

Sanada

Yamaguchi

Miyake

2021

Cureus

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Dialysis disequilibrium syndrome (DDS) is a neurological complication that has been known to occur after hemodialysis (HD). In recent years, the prevalence of DDS has been low as the symptoms are widely recognized; hence, preventive therapies, such as the slow and gentle procedure for HD, are often administered before starting dialysis. However, once DDS occurs, it may cause seizures, coma, and even death in severe cases. Since there has been no established treatment, recognizing risk factors and preventing the syndrome is important. A 76-year-old man was admitted to our hospital due to exacerbation of chronic heart failure. He also had a history of chronic kidney disease and had consulted with his home doctor about the preparation for HD a month before admission. After treatment with diuretics, the symptoms ameliorated, but he experienced presyncope and malaise. Laboratory tests revealed acute anemia and a decrease in renal function. Upper gastrointestinal endoscopy revealed active bleeding from a gastric ulcer, which was successfully stopped. However, his consciousness deteriorated because of uremia; hence, HD was initiated. We used a cellulose triacetate membrane with a surface area of 1.3 m 2 and maintained a dialysate flow rate of 500 ml/min with a blood flow rate of 120 ml/min. Four hours after starting HD, he suddenly developed generalized tonic convulsions. The dialysis was immediately stopped, and the patient was transferred to an intensive care unit. A computed tomography scan of the head showed mild edematous change of the brain, and laboratory tests also revealed a rapid decrease of urea nitrogen. We rationalized that he might have developed DDS. After injection of levetiracetam for the treatment of seizures, we initiated continuous hemodiafiltration as renal replacement therapy. Fortunately, his consciousness gradually improved, and he was completely alert on day 18 after admission. With reference to our current report, DDS can occur even following acute kidney injury, as the progression rate of the injury and accumulation of blood urea may not correlate with the risk of the syndrome.

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“…At first DDS was believed to occur only in patients with acute kidney injury when hemodialysis was first initiated, but it has also been reported in patients with CKD [7,23].…”

Section: Discussionmentioning

confidence: 99%

Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD) Intracranial pressure in patients with ESRD

Rickli¹,

Cosmoski²,

Santos³

et al. 2020

Preprint

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End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period ( p <0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session ( p <0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.

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Dialysis disequilibrium syndrome leading to sudden brain death in a chronic hemodialysis patient

Cited by 12 publications

References 15 publications

<p>Dialysis disequilibrium syndrome prevention and management</p>

<p>Dialysis disequilibrium syndrome prevention and management</p>

Dialysis Disequilibrium Syndrome in a Patient With Acute Kidney Injury on Chronic Kidney Disease

Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD) Intracranial pressure in patients with ESRD

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