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Dialysis disequilibrium syndrome prevention and management

Kirtida Mistry
International Journal of Nephrology and Renovascular Disease 2019, 12: 69-77
The dialysis disequilibrium syndrome (DDS) is a clinical constellation of neurologic symptoms and signs occurring during or shortly following dialysis, especially when dialysis is first initiated. It is a diagnosis of exclusion occurring in those that are uremic and hyperosmolar, in whom rapid correction with renal replacement therapy leads to cerebral edema and raised intracranial pressure with resultant clinical neurologic manifestations. DDS is most commonly described in association with hemodialysis but can occur in patients with acute kidney injury requiring continuous renal replacement therapy (CRRT). To date, it has not been described in association with peritoneal dialysis. The syndrome is uncommon and becoming rarer, so performing randomized controlled trials to evaluate the effectiveness of potential therapies is almost impossible. This also makes studying the pathophysiology in humans challenging. It is associated with mortality but is also preventable, so identification of patients at risk, preventive measures, early recognition and prompt management of DDS will minimize morbidity and mortality associated with this syndrome. While the focus of this review is the prevention and management of DDS, there will be an emphasis on what is known about the pathophysiology because it strongly impacts the prevention and management strategies.


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katayoon samadi wrote:


hi sir
to the best of my knoledge, the mollecular weight of urea is about 58 KD not 113.
thank you for your useful review

Abbas Kanso wrote:


Thank you for the feedback. Actually, Urea molecular weight/molar mass is 60 grams/mol i.e. 60 Da rather than KD if I'm not mistaken .
In case I am wrong, I appologize in advance.

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