From the Research
Dialysis Disequilibrium Syndrome (DDS) is best managed with prevention and supportive care, focusing on gradual reduction of blood urea nitrogen (BUN) and maintaining plasma osmolality, with immediate interventions including slowing or stopping dialysis and administering hypertonic solutions for symptomatic patients, as supported by the most recent study 1. The management of DDS involves several key strategies to prevent and treat the condition. Prevention is the primary approach, which includes:
- Using slower initial dialysis rates with reduced blood flow (200-250 mL/min)
- Shorter first dialysis sessions (2 hours)
- Smaller surface area dialyzers for new patients
- Gradual reduction of BUN, aiming for no more than a 40% reduction in the first session
- Adding sodium or mannitol to the dialysate to maintain plasma osmolality during treatment
For symptomatic patients, immediate interventions include:
- Slowing or stopping dialysis
- Administering hypertonic solutions (3% saline at 100 mL over 15-30 minutes or mannitol 1 g/kg)
- Providing supportive care for specific symptoms
- Anticonvulsants like lorazepam 2-4 mg IV may be needed for seizures Severe cases with cerebral edema might require mechanical ventilation and intracranial pressure monitoring, as highlighted in a case report 2. High-risk patients, including those with pre-existing neurological conditions, severe uremia (BUN >175 mg/dL), or children, require particularly careful monitoring and more conservative initial dialysis parameters, as noted in a review of the syndrome's pathophysiology and management 3. The syndrome occurs because rapid removal of urea from the blood creates an osmotic gradient between blood and brain tissue, causing cerebral edema as water shifts into brain cells, a mechanism discussed in a study on the prevention and management of DDS 4.