Dialysis disequilibrium syndrome
The dialysis disequilibrium syndrome (DDS) is a situation characterised by development of neurological symptoms caused by rapid removal of urea during hemodialysis. It develops primarily from an osmotic gradient that develops between the brain and the plasma as a result of rapid haemodialysis. It usually occurs during the last hour of hemodialysis or thereafter. The diagnosis of DDS in patients with ESRD is mainly based on exclusion of other possible central nervous system disorders 1-2.
CT / MRI brain
May show evidence of cerebral oedema. ADC values may be increased on MRI.
Histroy and etymology
It was first described by A C Kennedy et al. in 1962 3.
- 1. Patel N, Dalal P, Panesar M. Dialysis disequilibrium syndrome: a narrative review. Semin Dial. 2008;21 (5): 493-8. Semin Dial (full text) - doi:10.1111/j.1525-139X.2008.00474.x - Pubmed citation
- 2. Chen CL, Lai PH, Chou KJ et-al. A preliminary report of brain edema in patients with uremia at first hemodialysis: evaluation by diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2007;28 (1): 68-71. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 3. Kennedy AC, Linton AL, Eaton JC. Urea levels in cerebrospinal fluid after haemodialysis. Lancet. 1998;1 (7226): 410-1. Pubmed citation