Nephrology: Dialysis disequilibrium
syndrome (DDS)
What are the differential diagnoses of DDS? - ANS-• Uraemia
• Subdural hematoma
• Cerebral infarction
• Intracerebral hemorrhage
• Meningitis
• Metabolic disturbances (hyponatremia, hypoglycemia)
• Drug-brought about encephalopathy
What are the risk elements for DDS? - ANS-Risk factors
• First dialysis treatment
• Markedly accelerated blood urea conc. Predialysis (i.E. >a hundred seventy five mg/dL or
60 mmol/L)
• Chronic kidney disease
• Severe metabolic acidosis
• Older age
• Pediatric px
• Pre-present neuro disease (head trauma, stroke, seizures)
• Conditions characterised through cerebral oedema (hyponatraemia, hepatic
encephalopathy, malignant HTN)
Conditions that increase permeability of blood brain barrier (i.E. Sepsis, vasculitis, TTP/HUS,
encephalitis, meningitis)
What are the symptoms & signs and symptoms of DDS? - ANS-Signs & signs and
symptoms commonly increase throughout or at once after haemodialysis or at some point of
initiation of a continuous renal substitute therapy (CRRT)
• Sx are commonly self-limited and normally solve within several hours
Early sx:
• Headache
• Nausea
• Disorientation
• Restlessness
• Blurred vision
• Asterixis
• Also sx related to dialysis:
○ Muscle cramps
○ Anorexia
○ dizziness
• Some px might also progress to confusion, seizures, coma, dying
syndrome (DDS)
What are the differential diagnoses of DDS? - ANS-• Uraemia
• Subdural hematoma
• Cerebral infarction
• Intracerebral hemorrhage
• Meningitis
• Metabolic disturbances (hyponatremia, hypoglycemia)
• Drug-brought about encephalopathy
What are the risk elements for DDS? - ANS-Risk factors
• First dialysis treatment
• Markedly accelerated blood urea conc. Predialysis (i.E. >a hundred seventy five mg/dL or
60 mmol/L)
• Chronic kidney disease
• Severe metabolic acidosis
• Older age
• Pediatric px
• Pre-present neuro disease (head trauma, stroke, seizures)
• Conditions characterised through cerebral oedema (hyponatraemia, hepatic
encephalopathy, malignant HTN)
Conditions that increase permeability of blood brain barrier (i.E. Sepsis, vasculitis, TTP/HUS,
encephalitis, meningitis)
What are the symptoms & signs and symptoms of DDS? - ANS-Signs & signs and
symptoms commonly increase throughout or at once after haemodialysis or at some point of
initiation of a continuous renal substitute therapy (CRRT)
• Sx are commonly self-limited and normally solve within several hours
Early sx:
• Headache
• Nausea
• Disorientation
• Restlessness
• Blurred vision
• Asterixis
• Also sx related to dialysis:
○ Muscle cramps
○ Anorexia
○ dizziness
• Some px might also progress to confusion, seizures, coma, dying
