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Raina R, Davenport A, Warady B, Vasistha P, Sethi SK, Chakraborty R, Khooblall P, Agarwal N, Vij M, Schaefer F, Malhotra K, Misra M. Dialysis disequilibrium syndrome (DDS) in pediatric patients on dialysis: systematic review and clinical practice recommendations. Pediatr Nephrol 2022; 37:263-274. [PMID: 34609583 DOI: 10.1007/s00467-021-05242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Dialysis disequilibrium syndrome (DDS) is a rare neurological complication, most commonly affecting patients undergoing new initiation of hemodialysis (HD), but can also be seen in patients receiving chronic dialysis who miss regular treatments, patients having acute kidney injury (AKI), and in those treated with continuous kidney replacement therapy (CKRT) or peritoneal dialysis (PD). Although the pathogenesis is not well understood, DDS is likely a result of multiple physiological abnormalities. In this systematic review, we provide a synopsis of the data available on DDS that allow for a clear picture of its pathogenesis, preventive measures, and focus on effective management strategies. METHODS We conducted a literature search on PubMed/Medline and Embase from January 1960 to January 2021. Studies were included if the patient developed DDS irrespective of age and gender. A summary table was used to summarize the data from individual studies and included study type, population group, age group, sample size, patient characteristics, blood and dialysate flow rate, and overall outcome. A descriptive analysis calculating the frequency of population size, symptoms, and various treatments was performed using R software version 3.1.0. RESULTS A total of 49 studies (321 samples) were identified and analyzed. Out of the included 49 studies, a total of 48 studies reported the presence of DSS among patients (1 study reported based on number of dialysis and therefore was not considered for analysis). Among these 48 studies, 74.3% (226/304) patients were reported to have DSS. The most common symptoms were nausea (25.2%), headache (24.8%), vomiting (23.9%), muscle cramps (18.1%), affected level of consciousness (8.8%), confusion (4.4%), and seizure (4.9%) among the 226 DDS patients. Furthermore, 12 studies decided to switch from HD to alternative dialysis modalities including continuous venovenous hemofiltration/hemodiafiltration (CVVH/CVVHDF) or PD which reported no DDS symptoms. CONCLUSION Early recognition and timely prevention are crucial for DDS patients. We have provided comprehensive clinical practice points for pediatric, adolescent, and young adult populations. However, it is essential to recognize that DDS was reported more frequently in the early dialysis era, as there was a lack of advanced dialysis technology and limited resources.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA. .,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA. .,School of Medicine Cleveland Ohio, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrew Davenport
- University College London Centre for Nephrology, Division of Medicine, University College London Medical School, Royal Free Hospital, London, UK
| | - Bradley Warady
- Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy, Kansas City, MO, USA
| | - Prabhav Vasistha
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Sidharth Kumar Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, MedantaThe Medicity Hospital, Gurgaon, India
| | - Ronith Chakraborty
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
| | - Prajit Khooblall
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Nirav Agarwal
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Manan Vij
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Franz Schaefer
- Department of Pediatric Nephrology, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Kunal Malhotra
- Division of Nephrology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Madhukar Misra
- Division of Nephrology, University of Missouri School of Medicine, Columbia, MO, USA
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2
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Joannidis M, Forni LG, Klein SJ, Honore PM, Kashani K, Ostermann M, Prowle J, Bagshaw SM, Cantaluppi V, Darmon M, Ding X, Fuhrmann V, Hoste E, Husain-Syed F, Lubnow M, Maggiorini M, Meersch M, Murray PT, Ricci Z, Singbartl K, Staudinger T, Welte T, Ronco C, Kellum JA. Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup. Intensive Care Med 2019; 46:654-672. [PMID: 31820034 PMCID: PMC7103017 DOI: 10.1007/s00134-019-05869-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). METHODS A consensus conference on the spectrum of lung-kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. CONCLUSION The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung-kidney interactions to improve care processes and outcomes in critical illness.
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Affiliation(s)
- Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Lui G Forni
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK.,Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Doctoral College Medical Law and Healthcare, Faculty of Law, University Innsbruck, Innsbruck, Austria
| | - Patrick M Honore
- Department of Intensive Care Medicine, CHU Brugmann University Hospital, Brussels, Belgium
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - John Prowle
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Translational Medicine, University of Eastern Piedmont "A. Avogadro", Maggiore della Carità University Hospital, Novara, Italy
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France
| | - Xiaoqiang Ding
- Department of Nephrology, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medicine B, University Muenster, Muenster, Germany
| | - Eric Hoste
- ICU, Ghent University Hospital, Ghent, Belgium.,Research Fund-Flanders (FWO), Brussels, Belgium
| | - Faeq Husain-Syed
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Matthias Lubnow
- Department of Cardiology, Pulmonary and Critical Care Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marco Maggiorini
- Medical Intensive Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Melanie Meersch
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Patrick T Murray
- School of Medicine, University College Dublin, Dublin, Ireland.,UCD Catherine McAuley Education and Research Centre, Dublin, Ireland
| | - Zaccaria Ricci
- Department of Cardiology and Cardiac Surgery, Paediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Kai Singbartl
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Thomas Staudinger
- Department of Medicine I, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Tobias Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padua, Italy.,International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA
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3
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Mistry K. Dialysis disequilibrium syndrome prevention and management. Int J Nephrol Renovasc Dis 2019; 12:69-77. [PMID: 31118737 PMCID: PMC6503314 DOI: 10.2147/ijnrd.s165925] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Kirtida Mistry
- Division of Nephrology, Children's National Health System, Washington, DC 20010, USA
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4
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Dalia T, Tuffaha AM. Dialysis disequilibrium syndrome leading to sudden brain death in a chronic hemodialysis patient. Hemodial Int 2018; 22:E39-E44. [PMID: 29360280 DOI: 10.1111/hdi.12635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/19/2017] [Indexed: 11/27/2022]
Abstract
Dialysis disequilibrium syndrome (DDS) is a rare central nervous system (CNS) disease which develops in patients receiving hemodialysis (HD). Although it has been reported in patients receiving chronic HD, DDS is more common during or immediately after the first HD treatment. The exact incidence of DDS is unknown. Death in DDS is an extremely rare phenomenon and to the best of our knowledge only 9 cases have been reported showing this association. We present a unique case of a 42-year-old female on chronic HD, and no prior history of CNS disease, who developed brain death in the setting of DDS 2 hours into the dialysis treatment. A literature review of all previously reported cases was performed.
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Affiliation(s)
- Tarun Dalia
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ahmad M Tuffaha
- Department of Nephrology, University of Kansas Medical Center, Kansas City, Kansas, USA
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5
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Kuiper M, Hendrikx S, Koehler PJ. Headache and Tremor: Co-occurrences and Possible Associations. Tremor Other Hyperkinet Mov (N Y) 2015; 5:285. [PMID: 26175954 PMCID: PMC4472994 DOI: 10.7916/d8p55mkx] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/12/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tremor and headache are two of the most prevalent neurological conditions. This review addresses possible associations between various types of tremor and headache, and provides a differential diagnosis for patients presenting with both tremor and headache. METHODS Data were identified by searching MEDLINE in February 2015, with the terms "tremor" and terms representing the primary headache syndromes. RESULTS Evidence for an association between migraine and essential tremor is conflicting. Other primary headaches are not associated with tremor. Conditions that may present with both tremor and headache include cervical dystonia, infectious diseases, hydrocephalus, spontaneous cerebrospinal fluid leaks, space-occupying lesions, and metabolic disease. Furthermore, both can be seen as a side effect of medication and in the use of recreational drugs. DISCUSSION No clear association between primary headaches and tremor has been found. Many conditions may feature both headache and tremor, but rarely as core clinical symptoms at presentation.
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6
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O'Sullivan P, Sajjad J, Abrar S, Marks C. Headache during haemodialysis in a patient with shunt: a cause for concern? BMJ Case Rep 2015; 2015:bcr-2014-208887. [PMID: 25819823 DOI: 10.1136/bcr-2014-208887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 20-year-old woman with a functioning ventriculoperitoneal (VP) shunt consistently reported unbearable vertex headaches and nausea during the last hour of her haemodialysis (HD) sessions. After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. She improved fully on cessation of HD, requiring simple analgaesia only, and continued dialysis three times per week. Several more distressing episodes of nausea and headaches compelled us to give intravenous mannitol during HD, resulting in temporary improvement. Subsequently, shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response.
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Affiliation(s)
| | - Jahangir Sajjad
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | - Sahibzada Abrar
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | - Charles Marks
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
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7
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Osgood M, Compton R, Carandang R, Hall W, Kershaw G, Muehlschlegel S. Rapid Unexpected Brain Herniation in Association with Renal Replacement Therapy in Acute Brain Injury: Caution in the Neurocritical Care Unit. Neurocrit Care 2014; 22:176-83. [DOI: 10.1007/s12028-014-0064-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Shaikh N, Louon A, Hanssens Y. Fatal dialysis disequilibrium syndrome: A tale of two patients. J Emerg Trauma Shock 2011; 3:300. [PMID: 20930984 PMCID: PMC2938505 DOI: 10.4103/0974-2700.66555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 04/24/2010] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Dialysis disequilibrium syndrome (DDS) is a central nervous system disorder, which occurs during hemodialysis (HD) or within 24 h following the first HD. DDS commonly occurs in patients suffering from end-stage renal failure undergoing HD for the first time. In a critically ill patient suffering from severe sepsis or septic shock, the combined effects of post-HD brain edema and changes in the brain due to septic encephalopathy, may become amplified leading to DDS. Here we report 2 cases with acute renal failure (ARF), undergoing HD for more than a week and being ventilated and who developed DDS. DDS might have contributed to the sudden deterioration and death in these septic patients. The first case was a 31-year-old male, involved in a motor vehicle accident and had a severe abdominal injury. Underwent laparotomy and hemostasis was achieved. On day 4, the patient developed hemorrhagic shock associated with ARF, which prompted daily HD. On day 8, he went into septic shock. On day 16, 1 h after his daily HD, he became unresponsive and his pupils became dilated and fixed and he expired 2 days later. The second case was a young male who suffered severe abdominal and chest injury after a fall from a height. He developed ARF on day 3 and required HD. On day 9, he had septic shock. Three days later, during his daily HD, he became unconscious and his pupils were not reacting to light and the patient died on day 12. CONCLUSION In patients with severe sepsis/septic shock, DDS may occur even after repeated sessions of HD. The acute care physicians, intensivists, and nephrologists should be aware of the risks of DDS.
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Affiliation(s)
- Nissar Shaikh
- Department of Anesthesia/ICU and Pain Mangt, Hamad Medical Corporation, Doha-Qatar
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9
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Curtis CE, Rothstein M, Hong BA. Stage-specific educational interventions for patients with end-stage renal disease: psychological and psychiatric considerations. Prog Transplant 2009. [PMID: 19341059 DOI: 10.7182/prtr.19.1.y176571453728025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To optimize the success of educational interventions for adults with end-stage renal disease, we developed a psychosocial framework of illness adjustment. Currently, no stage-specific guidelines are available for understanding the psychosocial concerns of patients with end-stage renal disease nor are there specific models of coping with the disease. The content and implementation of educational programs must correspond to a patient's stage of adjustment to the illness. Psychological or psychiatric concerns may also affect participation in and response to educational interventions. Recommendations for structuring and implementing educational interventions about renal replacement that are specific to the unique psychosocial tasks associated with adjusting to each stage of end-stage renal disease are presented. Increased information about this disease and the treatment options available can be instrumental in improving patients' quality of life.
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Affiliation(s)
- Carmen E Curtis
- Washington University School of Medicine, Campus Box 8134, 660 S. Euclid Ave, St Louis, MO 6311, USA
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10
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Koch BCP, Nagtegaal JE, Kerkhof GA, ter Wee PM. Circadian sleep–wake rhythm disturbances in end-stage renal disease. Nat Rev Nephrol 2009; 5:407-16. [DOI: 10.1038/nrneph.2009.88] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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11
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Curtis CE, Rothstein M, Hong BA. Stage-Specific Educational Interventions for Patients with End-Stage Renal Disease: Psychological and Psychiatric Considerations. Prog Transplant 2009; 19:18-24. [DOI: 10.1177/152692480901900103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To optimize the success of educational interventions for adults with end-stage renal disease, we developed a psychosocial framework of illness adjustment. Currently, no stage-specific guidelines are available for understanding the psychosocial concerns of patients with end-stage renal disease nor are there specific models of coping with the disease. The content and implementation of educational programs must correspond to a patient's stage of adjustment to the illness. Psychological or psychiatric concerns may also affect participation in and response to educational interventions. Recommendations for structuring and implementing educational interventions about renal replacement that are specific to the unique psychosocial tasks associated with adjusting to each stage of end-stage renal disease are presented. Increased information about this disease and the treatment options available can be instrumental in improving patients' quality of life.
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Affiliation(s)
| | | | - Barry A. Hong
- Washington University School of Medicine, St Louis, Missouri
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12
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Lin CM, Lin JW, Tsai JT, Ko CP, Hung KS, Hung CC, Su YK, Wei L, Chiu WT, Lee LM. Intracranial pressure fluctuation during hemodialysis in renal failure patients with intracranial hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2009; 101:141-4. [PMID: 18642649 DOI: 10.1007/978-3-211-78205-7_24] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coagulopathy in renal failure patients often makes them vulnerable to intracranial hemorrhage. Emergency decompression to remove the hematoma and to stop bleeding is always indicated. After the surgery, hemodialysis (HD) should be arranged to maintain the BUN/Cr. level, and I/O balance. During HD, intracranial pressure in all of the patients in this study fluctuated. This phenomenon always resulted in neurological deterioration in acute or chronic renal failure. We present intracranial pressure (ICP) changes during HD in five acute or chronic renal failure patients with intracranial hemorrhage. They all underwent craniectomy or craniotomy with ICP monitors implantation. Different HD protocols were arranged for these patients and then we observed clinical results. ICP elevated during HD and resulted in severe brain swelling. This situation was one of the clinical presentations of dialysis disequilibrium syndrome (DDS). Four patients died because of this complication and one survived. ICP fluctuation seemed to be correlated with the fluid amount and frequency of HD. The prevalence and pathophysiology of DDS remain unclear. Renal failure patient with intracranial hemorrhage may be complicated with DDS when HD was performed. An attempt to reduce the fluid amount and to increase the frequency of HD might help these patients.
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Affiliation(s)
- C M Lin
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
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13
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14
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Kendirli T, Ekim M, Ozçakar ZB, Yüksel S, Acar B, Oztürk-Hiişmi B, Derelli E, Kavaz A, Yalaki Z, Yalçinkaya F. Renal replacement therapies in pediatric intensive care patients: experiences of one center in Turkey. Pediatr Int 2007; 49:345-8. [PMID: 17532833 DOI: 10.1111/j.1442-200x.2007.02376.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children. METHODS The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005. RESULTS Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient. CONCLUSION In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.
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Affiliation(s)
- Tanil Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
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15
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Chiu A, Chan LMY, Fan ST. Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience. Liver Int 2006; 26:695-702. [PMID: 16842326 DOI: 10.1111/j.1478-3231.2006.01293.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND The molecular adsorbent recirculating system (MARS) is an extracorporeal liver dialysis system that allows selective removal of bilirubin and other albumin-bound toxins. We reported here our experience with the use of this technique for management of liver failure at Queen Mary Hospital, Hong Kong. METHODS From December 2002 to 2004, a total of 74 MARS sessions were performed on 22 patients. The cause of liver failure included acute liver failure (n = 2), acute on chronic liver failure (n = 12), posthepatectomy liver failure (n = 4), and posttransplantation allograft failure (n = 4). RESULTS MARS treatment showed significant reduction in total bilirubin level, serum ammonia level and blood urea, and nitrogen (P < 0.001 for all three parameters). Five patients (22.7%) were able to bridge to transplantation and one patient (4.5%) made a spontaneous recovery. The 30-day mortality rate was 72.7%. CONCLUSIONS Our results indicated that MARS can effectively improve serum biochemistry and is suitable for temporarily supporting patients with liver failure where transplantation is not immediately available. There is, however, no clear evidence showing that MARS can increase survival, improve the chance of transplantation or assist liver regeneration. Future studies in the form of randomized-controlled trials are crucial to characterize the true potential of this treatment.
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Affiliation(s)
- Alexander Chiu
- Intensive Care Unit, Queen Mary Hospital, Hong Kong, China
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16
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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; 5:9. [PMID: 15318947 PMCID: PMC515303 DOI: 10.1186/1471-2369-5-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 08/19/2004] [Indexed: 11/10/2022] Open
Abstract
Background Dialysis disequilibrium syndrome (DDS) is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD). We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. Case Presentation A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L). Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L) (urea-reduction-ratio 71%). Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. Head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. Brain death was declared. Conclusions Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia.
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Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
| | - Adam D Peets
- Department of Critical Care Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
| | - Morad Hameed
- Department of Critical Care Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
| | - Paul JE Boiteau
- Department of Critical Care Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
| | - Kevin B Laupland
- Department of Critical Care Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
- Department of Diagnostic and Laboratory Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
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Mehta RL, Clark WC, Schetz M. Techniques for assessing and achieving fluid balance in acute renal failure. Curr Opin Crit Care 2002; 8:535-43. [PMID: 12454538 DOI: 10.1097/00075198-200212000-00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fluid therapy, together with attention to oxygen supply, is the cornerstone of resuscitation in all critically ill patients. Hypovolemia results in inadequate blood flow to meet the metabolic requirements of the tissues and must be treated urgently to avoid the complication of progressive organ failure, including acute renal failure. The kidney plays a critical role in body fluid homeostasis. Renal dysfunction disturbs this homeostasis and requires special attention to issues of fluid balance and fluid overload. In addition, fluid therapy is the only treatment that has been shown to be effective in the prevention of acute renal failure. Special attention to volume status is therefore required in patients at risk for acute renal failure. Hypovolemia is also a major causal factor of morbidity during hemodialysis and may contribute to further renal insults. Although the importance of fluid management is generally recognized, the choice of fluid, the amount, and assessment of fluid status are controversial. As the choice of fluids becomes wider and monitoring devices become more sophisticated, the controversy increases. This article provides an overview of the concept of fluid management in the critically ill patient with acute renal failure.
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Affiliation(s)
- Ravindra L Mehta
- Department of Medicine, Division of Nephrology, University of California, San Diego, California, USA.
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