Dialysis disequilibrium syndrome

In nephrology, dialysis disequilibrium syndrome, commonly abbreviated DDS, is the occurence of neurologic signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis.^[1]

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Classically, DDS arises in individuals starting hemodialysis due to chronic renal failure and is associated, in particular, with "aggressive" (high solute removal) dialysis.^[2] However, it may also arise in fast onset, i.e. acute, renal failure in certain conditions.

DDS is a reason why hemodialysis initiation is usually done gradually, i.e. it is a reason the first few dialysis sessions are shorter than is typical in an end-stage renal disease patient.

Etiology

The cause of DDS is currently not well understood.

There are two theories to explain it; the first theory postulates that urea transport from the brain cells is slowed in chronic renal failure, leading to a large urea concentration gradient, which resulting in reverse osmosis. The second theory postulates that organic compounds are increased in uremia to protect the brain and result in injury by, like in the first theory, reverse osmosis.^[1]

References

1. ^ ^{a b} Bagshaw SM, Peets AD, Hameed M, Boiteau PJ, Laupland KB, Doig CJ (2004). "Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report". BMC Nephrol 5: 9. doi:10.1186/1471-2369-5-9. PMID 15318947. Free Full Text.
2. ^ Port FK, Johnson WJ, Klass DW (1973). "Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate". Kidney Int. 3 (5): 327–33. PMID 4792047. Free Full Text.

See also

• Renal failure