From the Research
Dialysis disequilibrium syndrome (DDS) is a rare neurological complication that occurs in patients undergoing hemodialysis, particularly during the initiation of treatment, and is characterized by symptoms such as nausea, headache, vomiting, and muscle cramps, which can be prevented and managed with careful monitoring and adjustment of dialysis parameters. According to a systematic review and clinical practice recommendations published in 2022 1, DDS is likely a result of multiple physiological abnormalities, and its pathogenesis is not well understood. The review included 49 studies with a total of 321 samples and found that 74.3% of patients reported symptoms of DDS, with the most common symptoms being nausea, headache, vomiting, and muscle cramps.
Key Characteristics of Dialysis Disequilibrium Syndrome
- Rare neurological complication of hemodialysis
- Occurs during or shortly after hemodialysis treatment
- Characterized by symptoms such as nausea, headache, vomiting, and muscle cramps
- Can be prevented and managed with careful monitoring and adjustment of dialysis parameters
Prevention and Management of Dialysis Disequilibrium Syndrome
- Using slower, gentler initial dialysis sessions with reduced blood flow rates, shorter treatment times, and smaller dialyzers
- Sodium modeling, where dialysate sodium concentration is gradually decreased during treatment
- Administering hypertonic solutions like mannitol or hypertonic saline if symptoms develop
- Providing supportive care and closely monitoring patients with risk factors such as advanced age, pre-existing neurological conditions, or severe kidney failure
A more recent case report published in 2024 2 highlights the importance of early recognition and prompt management of DDS to minimize morbidity and mortality. The report emphasizes the need for awareness of this uncommon entity and discusses the clinical features, prevention, and pathophysiology of DDS. Overall, the key to preventing and managing DDS is careful monitoring and adjustment of dialysis parameters, as well as early recognition and prompt treatment of symptoms.