From the Guidelines
Yes, dialysis disequilibrium syndrome can manifest as mood changes and agitation. Dialysis disequilibrium syndrome (DDS) is a neurological complication that can occur during or shortly after hemodialysis, particularly in patients new to dialysis or those with significant uremia. The syndrome typically presents with neurological symptoms that range from mild (headache, nausea, restlessness) to severe (confusion, seizures, coma). Mood changes and agitation are among the moderate manifestations of DDS and may be accompanied by irritability, anxiety, and altered mental status. These symptoms occur due to rapid changes in blood chemistry during dialysis, particularly rapid removal of urea, which creates an osmotic gradient between the blood and brain tissue. This gradient causes water to shift into brain cells, leading to cerebral edema and increased intracranial pressure, which in turn affects neurological function and behavior. Although the provided evidence does not directly discuss dialysis disequilibrium syndrome, it highlights the importance of managing the symptom burden associated with maintenance dialysis, including psychological interventions such as cognitive behavioral therapy, which has efficacy in reducing depression 1. To prevent DDS, dialysis should be initiated gradually in high-risk patients with shorter sessions and slower blood flow rates. If mood changes and agitation occur during dialysis, slowing or temporarily stopping the procedure may be necessary, and symptoms should be managed supportively while addressing the underlying osmotic shifts. Some studies suggest that interventions like mindfulness, music, and spiritual interventions may reduce the prevalence of depressive symptoms, which could be beneficial in managing mood changes and agitation in patients undergoing dialysis 1. However, it is crucial to prioritize the prevention and management of DDS based on the most recent and highest quality evidence available.
From the Research
Dialysis Disequilibrium Syndrome Manifestations
- The syndrome can manifest with various neurological symptoms, including seizures, altered mental status, and coma 2, 3, 4.
- Restlessness and headache are also common symptoms of dialysis disequilibrium syndrome 4.
- The development of cerebral edema and increased intracranial pressure are the primary contributing factors to this syndrome 3, 5, 4.
Mood Changes and Agitation
- While the provided studies do not specifically mention mood changes and agitation as common manifestations of dialysis disequilibrium syndrome, restlessness is mentioned as a symptom 4.
- Restlessness can be related to mood changes and agitation, but there is no direct evidence to support this as a common manifestation of the syndrome 4.
- The studies focus more on the severe neurological manifestations such as seizures, coma, and death 2, 3, 4.
Prevention and Management
- Prevention of dialysis disequilibrium syndrome is crucial, as treatment once it has developed is rarely successful 4.
- Identifying high-risk patients, implementing preventive measures, and ensuring early detection and prompt management of dialysis disequilibrium syndrome can help minimize morbidity and mortality 3, 5.