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American Journal of Medical Case Reports. 2018, 6(4), 68-71
DOI: 10.12691/AJMCR-6-4-4
Case Report

Dialysis Disequilibrium Syndrome

Christina George D.O1, , Sreelatha Penumalee M.D2 and David Minter D.O1

1Department of Emergency Medicine, McLaren Oakland, Pontiac, USA

2Department of Nephrology, McLaren Oakland, Pontiac, USA

Pub. Date: May 08, 2018

Cite this paper

Christina George D.O, Sreelatha Penumalee M.D and David Minter D.O. Dialysis Disequilibrium Syndrome. American Journal of Medical Case Reports. 2018; 6(4):68-71. doi: 10.12691/AJMCR-6-4-4

Abstract

Dialysis disequilibrium syndrome (DDS) is a rare complication of dialysis leading to neurological symptoms which can vary in severity from a simple headache to coma and death. The debate continues on the specific causes of DDS and centers around two main theories; the reverse urea effect and cerebral acidosis. It can be a challenge to predict in which patients DDS will occur, and an even more difficult syndrome to treat while the best known treatment is prevention. A case where DDS led to irreversible brain damage despite preventative measures in place will be discussed along with a discussion of current literature surrounding dialysis disequilibrium syndrome (DDS) and its treatment.

Keywords

dialysis, disequilibrium syndrome, cerebral edema, osmolality

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Ali II, Pirzada NA. Neurologic complications associated with dialysis and chronic renal insufficiency. In: Principles and Practice of Dialysis, Henrich WL (Ed), Lippincott, Williams & Wilkins, Philadelphia 2004, p. 507.
 
[2]  Arieff A, Massry S, Barrientos A, Kleeman C. Brain water and electrolyte metabolism in uremia: effects of slow and rapid hemodialysis. Kidney Int. 1973; 4(3): 177-187.
 
[3]  Arieff A, Guisado R, Massry S, Lazarowitz C. Central nervous system pH in uremia and the effects of hemodialysis. J Clin Invest. 1976; 58: 306-311.
 
[4]  Arieff A. Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention. Kidney Int. 1994; 45(3): 629-635.
 
[5]  Bagshaw S, Peets A, Hameed M, Boiteau P, Laupland K, Doig C. Dialysis Disequilibrium Syndrome: Brain death following hemodialysis for metabolic acidosis and acute renal failure. BMC Nephrology. 2004; 5-9.
 
[6]  Bergman H, Daugirdas J, Ing T. Complications during hemodialysis. In: Handbook of Dialysis. Daugirdas JG, Blake PG, Ing TS, Lippincott, Williams & Wilkins. 2001.
 
[7]  Galons J, Trouard T, Gmitro A, Lien Y. Hemodialysis increases apparent diffusion coefficient of brain water in nephrectomized rats measured by isotropic diffusion- weighted magnetic resonance imaging. J Clin Invest. 1996; 98:750-755.
 
[8]  Hu M, Bankir L, Michelet S, Rousselet G, Trinh-Trang-Tan M. Massive reduction of urea transporters in remnant kidney and brain of uremic rats. Kidney Int. 2000; 58: 1202-1210.
 
[9]  Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney inter., Suppl. 2012;2: 1-138.
 
[10]  Kishimoto T, Yamagami S, Tanaka H, Ohyama T, Yamamoto T, Yamakawa M, et al. Superiority of hemofiltration to hemodialysis for treatment of chronic renal failure: comparative studies between hemofiltration and hemodialysis on dialysis disequilibrium syndrome. Artif Organs. 1980; 4(2): 86-93.
 
[11]  Mandeep S, Tarek D, Ramin S, Andrews J. Dialysis Disequilibrium Syndrome Revisited. Hemodialysis International. 2001; 5: 92-96.
 
[12]  Marcelle M, Tan T, Cartron, J, Bankir L. Molecular basis for the dialysis disequilibrium syndrome: Altered aquaporin and urea transporter expression in the brain. Nephrology Dialysis Transplantation. 2005; 20: 1984-1988.
 
[13]  Patel N, Dalal, P, Panesar M. Dialysis Disequilibrium Syndrome: A Narrative Review. Seminar in Dialysis. 2008; 20(3): 493-498.
 
[14]  Rodrigo F, Shideman J, McHugh R, Buselmeier T, Kjellstrand C. Osmolality changes during hemodialysis. Natural history, clinical correlations, and influence of dialysate glucose and intravenous mannitol. Ann Inten Med. 1977; 86: 554-561.
 
[15]  Rosa A, Shideman J, McHugh R, Duncan D, Kjellstrand C. The importance of osmolality fall and ultrafiltration rate on hemodialysis side effects. Influence of intravenous mannitol. Nephron. 1981; 27: 134-141.
 
[16]  Silver S. Cerebral edema after rapid dialysis is not caused by an increase in brain organic osmolytes. J Am Soc Nephrol. 1995; 6: 1600-1606.
 
[17]  Silver M, DeSimone J, Smith D, Sterns R, Dialysis disequilibrium syndrome in the rat and role of the “reverse urea effect.” Kidney Int. 1992; 42: 161-166.
 
[18]  Silver S, Sterns R, Halperin M. Brain swelling after dialysis: old urea or new osmoles? Am J Kidney Dis. 1996; 28(1): 1-13.
 
[19]  Trinh-Trang-Tan M, Cartron J, Bankir L. Molecular basis for the dialysis disequilibrium syndrome: altered aquaporin and urea’s transporter expression in the brain. Nephrol Dial Transplant. 2005; 20(9): 1984-1988.
 
[20]  Zepeda-Orozco D, Quigley R. Dialysis Disequilibrium Syndrome. Pediatric Nephrology. 2012; 27: 2205-2211.