Water content (cerebral edema).4 In most of theĮxperimental studies, however, brain edema was a An increase in CSF pressure, however, may be secondary to either increased CSF volume, increased brain blood volume (cerebral vasodilation), or increased brain Of elevated CSF pressure is thought by many to Uremic humans or laboratory animals with acute In both uremic patients and experimental animals A rise in cerebrospinal fluid (CSF) pressure, intracellular acidosis of brain, and brainĮdema may all be contributory. The pathogenesis of DDS is not fully understood. Nausea, weakness, headache, fatigue, and muscle © 1987 by the National Kidney Foundation, 11lc. Supported by Grant 7219 from the Special Services and Research Committee of University of Alberta Hospitals and from aĭr Basile is a recipielll of the Len Grasley Memorial Research Fellowship granted by the Kidney Foundation ofĪddress reprilll requests to Carlo Basile, MD, Via Battisti and the Department of Applied Sciences ill Medicin e, University of Alberta, Edmonton, Whereas the symptoms of DDS reported in theġ970s have generally been mild, consisting ofįrom the Department of Medicine. Most of the seizures,Ĭomas, and deaths were reported prior to 1970, 1.2 It appears that modern methods of dialysis have altered To seizures, arrhythmias, and even coma). Headache, muscle cramps, and fatigue followingĭialysis) to severe (eg, medical emergencies due Ranging from mild (eg, nausea, vomiting, (DDS) describes a constellation of symptoms INDEX WORDS: Dialysis disequilibrium syndrome computed tomography EEG spectral analysis hypertonic hemodiafiltration standard hemodialysis. © 1987 by the National Kidney Foundation, Inc. Most of the uremic stable patients on maintenance HD are highl y unlikely to develop DDS under Thus, DDS must beĬonsidered a peculiarity of rapid HD in patients affected by acute renal failure or at the start of their program of Group of stable uremic patients undergoing both a rapid and a standard dialysis treatment. Shows neither a postdialysis change In brain density and ventricular size nor a postdlalysls EEG deterioration in a In addition, no significant in-between- and withintreatment difference was observed when analyzing the EEG% power (3-7/7-13 Hz) data. Ventricles or in the transverse diameter of the third ventricle. Furthermore, no difference was evident either in the bicaudate diameter of the lateral
Structures (base and apical cuts), when comparing pre- v post-HD, pre- v post-H HDF, pre- HD v pre-H HDF, and No difference was found in the density of seven specific brain Treatment were allowed before these studies. Approximately 6 weeks of stabilization on each
Min) and a H HDF run (three hours, blood flow rate 400 ml/min). Of the brain, and blood biochemistry were performed before and after a HD (four hours, blood flow rate 250 mll H HDF is a dialysis technique that is shorter and more efficient than HD. They volunteeredįor a randomized crossover study of 4 months each of standard hemodialysis (HD) and hypertonic hemodiafiltration (H HDF). Ventricular size (computed tomography of the brain) In a group of 11 stable uremic patients. This study was designed toĪnalyze the changes induced by dialysis in the EEG pattern (spectral analysis), in the cerebral hydration, and Both are manifestations of the dialysis disequilibrium syndrome (DDS). Cerebral edema in uremic animals and humans, as well as an EEG deterioration in humans, has been reportedĪfter dialysis.The Effects of Dialysis on Brain Water andĬarlo Basile, MD, Jack D.R.