Exploring Prevalence and Predictors of Clinically Suspected Dialysis Disequilibrium Syndrome in End-Stage Kidney Disease Patients Initiating Hemodialysis

Budsarawadee Nookaew; Ussanee Boonsrirat; Suwikran Wongpraphairot; Sirihatai Konwai; Suntornwit Praditaukrit; Atthaphong Phongphithakchai

doi:10.31584/jhsmr.20241120

Exploring Prevalence and Predictors of Clinically Suspected Dialysis Disequilibrium Syndrome in End-Stage Kidney Disease Patients Initiating Hemodialysis

Budsarawadee Nookaew, Ussanee Boonsrirat, Suwikran Wongpraphairot, Sirihatai Konwai, Suntornwit Praditaukrit, Atthaphong Phongphithakchai

Abstract

Objective: This study aimed to examine the prevalence and predictors of clinically suspected dialysis disequilibrium syndrome (DDS) in end-stage kidney disease (ESKD) patients starting their first hemodialysis session.
Material and Methods: Data was retrospectively collected from a university hospital; from december 2020 to july 2023. It included adult patients receiving their first session of hemodialysis. Patient demographics, comorbidities, medications, and laboratory results were analyzed. The primary objective was to identify clinically suspected DDS using predefined criteria. Multivariate logistic regression was used to identify independent risk factors for clinically suspected DDS.
Results: A total of 106 patients were enrolled. Among these, 18.8% had clinically suspected DDS, with nausea being the most prevalent symptom. The onset of symptoms varied, with a median of 240 minutes. Multivariate analysis revealed higher pre-hemodialysis serum creatinine as a risk factor for DDS (adjusted OR: 1.13; 95% CI: 1.02–1.25), while lower pre-hemodialysis serum sodium (adjusted OR: 0.90; 95% CI: 0.84–0.98) and capillary blood glucose levels (adjusted OR: 0.99; 95% CI: 0.97–1.0) were associated with increased risk. Notably, elevated blood glucose levels were protective against DDS.
Conclusion: Higher pre-dialysis serum creatinine, coupled with lower sodium and glucose levels significantly predicts DDS. These findings emphasize the necessity of tailored hemodialysis prescriptions and vigilant monitoring of patients likely to develop DDS.

Keywords

dialysis disequilibrium syndrome; end-stage kidney disease; hemodialysis; prevalence; risk factors; neurological symptoms

Full Text:

PDF

References

Arieff AI. Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention. Kidney Int 1994;45:629–35.

Wakim KG, Johnson WJ, Klass DW. Role of blood urea and serum sodium concentrations in the pathogenesis of the dialysis dysequilibrium syndrome. Trans Am Soc Artif Intern Organs 1968;14:394–401.

Kleeman CR, Davson H, Levin E. Urea transport in the central nervous system. Am J Physiol 1962;203:739–47.

Raina R, Davenport A, Warady B, Vasistha P, Sethi SK, Chakraborty R, et al. Dialysis disequilibrium syndrome (DDS) in pediatric patients on dialysis: systematic review and clinical practice recommendations. Pediatr Nephrol 2022;37:263–74.

Arieff AI, Guisado R, Massry SG, Lazarowitz VC. Central nervous system ph in uremia and the effects of hemodialysis. J Clin Invest 1976;58:306–11.

Posner JB, Plum F. Spinal-fluid ph and neurologic symptoms in systemic acidosis. N Engl J Med 1967;277:605–13.

Mistry K. Dialysis disequilibrium syndrome prevention and management. Int J Nephrol Renovasc Dis 2019;12:69–77.

Patel N, Dalal P, Panesar M. Dialysis disequilibrium syndrome: a narrative review. Semin Dial 2008;21:493–8.

Bagshaw SM, Peets AD, Hameed M, Boiteau PJE, Laupland KB, Doig CJ. Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BMC Nephrol 2004;19;5–9.

KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024;105:s117–314.

Raja SM, Seyoum Y. Intradialytic complications among patients on twice-weekly maintenance hemodialysis: an experience from a hemodialysis center in Eritrea. BMC Nephrol 2020;21:163.

Ali M, Bakhsh U. A vanishing complication of haemodialysis: Dialysis disequilibrium syndrome. J Intensive Care Soc 2020;21:92–5.

Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361:1627–38.

Trachtman H, Futterweit S, Tonidandel W, Gullans SR. The role of organic osmolytes in the cerebral cell volume regulatory response to acute and chronic renal failure. J Am Soc Nephrol 1993;3:1913–9.

Flanigan MJ. Role of sodium in hemodialysis. Kidney Int Suppl 2000;76:S72-8.

Raja R, Kramer M, Barber K, Chen S. Sequential changes in dialysate sodium (DNa) during hemodialysis. Trans Am Soc Artif Intern Organs 1983;29:649–51.

DOI: http://dx.doi.org/10.31584/jhsmr.20241120

Refbacks

There are currently no refbacks.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.