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Kim JH, Jeong HC, Shin YU, Lee WJ. Hemodialysis-induced positional changes in lamina cribrosa. Sci Rep 2024; 14:15250. [PMID: 38956090 PMCID: PMC11219866 DOI: 10.1038/s41598-024-65700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
This study is aimed to investigate the effect of hemodialysis (HD) on the lamina cribrosa (LC) of the optic nerve head (ONH) using swept-source optical coherence tomography (SS-OCT) and other ophthalmological parameters in patients with end-stage kidney disease (ESKD). This prospective observational study included 29 patients who underwent HD for ESKD. ONH parameters including neural canal diameter (NCD), peripapillary vertical height (PVH), and anterior LC depth (LCD), were assessed using SS-OCT. Changes in the ONH parameters before and after HD were statistically analysed. Correlations between changes in the LCD and other ocular and systemic measurements were identified using Pearson's correlation analyses. The mean anterior LCD significantly decreased from 441.6 ± 139.8 μm before HD to 413.5 ± 141.7 μm after HD (P = 0.001). Mean NCD and PVH did not show significant changes after HD (P = 0.841 and P = 0.574, respectively). A significant correlation was found between changes in the anterior LCD and the mean ocular perfusion pressure (r = 0.397, P = 0.036). We observed a significant decrease in anterior LCD after HD. Our study suggests that HD can influence the ONH, especially in the LC.
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Affiliation(s)
- Ji Hong Kim
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
| | - Hyo Chan Jeong
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea.
- Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 104763, Korea.
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Kulkarni M, Prabhu AR, Rao IR, Nagaraju SP. Interventions for preventing haemodialysis dysequilibrium syndrome. Cochrane Database Syst Rev 2024; 5:CD015526. [PMID: 38775299 PMCID: PMC11110491 DOI: 10.1002/14651858.cd015526.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Dialysis dysequilibrium syndrome (DDS) refers to neurological symptoms usually seen during or after new initiation or following reinitiation of haemodialysis (HD) after missing multiple sessions. DDS is associated with death and morbidity. We studied interventions aimed at preventing DDS. OBJECTIVES To evaluate the benefits and harms of different types of interventions for preventing DDS. SEARCH METHODS We contacted the information specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 8 May 2024 using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared any intervention against standard care, including individuals initiated on HD, regardless of age. DATA COLLECTION AND ANALYSIS Two authors independently determined study eligibility, assessed quality and extracted data. Data were collected on methods, interventions, participants, and outcomes (DDS incidence, severe DDS, death, adverse events). Risk ratios (RR) and confidence intervals (CI) were calculated. Study quality was assessed using the Cochrane Risk of Bias 2 (ROB2) tool. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We included two RCTs, enrolling 32 adult participants. Interventions included were slow dialysis, sodium modelling, standard sodium dialysate, and high sodium dialysate. The risk of bias was of some concern to high risk of bias in both studies. Slow dialysis compared to sodium modelling (1 study, 15 participants) may result in little to no difference in DDS, severe DDS, and death (low certainty evidence) and has uncertain effects on adverse events (RR 1.33, 95% CI 0.15 to 11.64; very low certainty evidence). Standard sodium dialysate compared to high sodium dialysate (1 study, 17 participants) has uncertain effects on the incidence of DDS (RR 0.07, 95% CI 0.00 to 1.12), severe DDS (RR 0.47, 95% CI 0.02 to 10.32), and adverse events (RR 0.29, 95% CI 0.08 to 1.02) (very low certainty evidence). AUTHORS' CONCLUSIONS In HD patients, sodium modelling, compared to slow dialysis, may result in little to no difference in DDS and death (low certainty evidence) and has uncertain effects on adverse events (very low certainty evidence). The evidence is very uncertain for the effect of high-sodium dialysate and standard sodium dialysate on DDS, death and adverse events (very low certainty evidence).
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Affiliation(s)
- Manjunath Kulkarni
- Department of Nephrology, Father Muller Medical College, Mangaluru, India
| | - Attur Ravindra Prabhu
- Department of Nephrology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
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Evans AR, Zhao X, Ernst GL, Ortiz-Garcia J, Dunn IF, Burke J. Dialysis disequilibrium syndrome in neurosurgery: literature review and illustrative case example. GeroScience 2024:10.1007/s11357-024-01109-z. [PMID: 38488947 DOI: 10.1007/s11357-024-01109-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The dialysis disequilibrium syndrome (DDS) is a complication in those undergoing dialysis for chronic kidney disease (CKD) or acute kidney injury (AKI), characterized by nonspecific symptoms that may progress to coma and death secondary to cerebral edema. This syndrome is associated with rapid change in electrolytes during dialysis with changes in intracranial pressure (ICP) and may have a higher incidence in the elderly neurosurgical patient population. METHODS Literature review and illustrative case example. RESULTS A 62-year-old female presented with acute mental status change during hemodialysis (HD), with a history of a nonsurgical acute subdural hematoma (SDH) 10 days prior. Imaging showed a conversion of the acute SDH to chronic SDH of 12.2 mm in size with a 14.1 midline shift, for which she underwent a hemicraniectomy with SDH evacuation, with a gradual return to baseline. The literature review identified 5 publications meeting the inclusion criteria. Major theories of DDS include a reverse urea effect, intracerebral acidosis, idiogenic osmoles, and local inflammation. This complication may occur more frequently in the elderly neurosurgical patient population, likely due to age-related comorbidities, preexisting neurological insult, and increased permeability of the blood-brain barrier (BBB), leading to cerebral edema. CONCLUSION DDS is a rare and potentially fatal complication of HD that may have a higher incidence in the elderly neurosurgical patient population, yet remains to be fully understood. Further study is recommended to characterize the pathophysiological mechanism and incidence of DDS in neurosurgical patients.
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Affiliation(s)
- Alexander R Evans
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | - Xiaochun Zhao
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | - Griffin L Ernst
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | - Jorge Ortiz-Garcia
- Department of Neurology, University of Oklahoma, Oklahoma City, United States
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | - John Burke
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA.
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Roskal-Wałek J, Gołębiewska J, Mackiewicz J, Bociek A, Wałek P, Biskup M, Bołtuć-Dziugieł K, Starzyk K, Odrobina D, Wożakowska-Kapłon B, Jaroszyński A. The Impact of a Single Haemodialysis Session on the Retinal Thickness and Optic Nerve Morphology. Diagnostics (Basel) 2024; 14:331. [PMID: 38337847 PMCID: PMC10855457 DOI: 10.3390/diagnostics14030331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients. METHODS It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD. RESULTS In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 μm, post-HD 272.14 ± 20.11 μm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm3, post-HD 7.52 ± 0.55 mm3; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 μm, post-HD 100.23 ± 14.7 μm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 μm, post-HD 70.6 ± 9.7 μm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 μm, post-HD 97.9 ± 12.94 μm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus. CONCLUSION Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.
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Affiliation(s)
- Joanna Roskal-Wałek
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
| | - Joanna Gołębiewska
- Department of Ophthalmology, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland
| | - Agnieszka Bociek
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | | | - Katarzyna Starzyk
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Dominik Odrobina
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Zhao H, Sun M, Zhang Y, Kong W, Fan L, Wang K, Xu Q, Chen B, Dong J, Shi Y, Wang Z, Wang S, Zhuang X, Li Q, Lin F, Yao X, Zhang W, Kong C, Zhang R, Feng D, Zhao X. Connecting the Dots: The Cerebral Lymphatic System as a Bridge Between the Central Nervous System and Peripheral System in Health and Disease. Aging Dis 2024; 15:115-152. [PMID: 37307828 PMCID: PMC10796102 DOI: 10.14336/ad.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023] Open
Abstract
As a recently discovered waste removal system in the brain, cerebral lymphatic system is thought to play an important role in regulating the homeostasis of the central nervous system. Currently, more and more attention is being focused on the cerebral lymphatic system. Further understanding of the structural and functional characteristics of cerebral lymphatic system is essential to better understand the pathogenesis of diseases and to explore therapeutic approaches. In this review, we summarize the structural components and functional characteristics of cerebral lymphatic system. More importantly, it is closely associated with peripheral system diseases in the gastrointestinal tract, liver, and kidney. However, there is still a gap in the study of the cerebral lymphatic system. However, we believe that it is a critical mediator of the interactions between the central nervous system and the peripheral system.
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Affiliation(s)
- Hongxiang Zhao
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Meiyan Sun
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Yue Zhang
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Wenwen Kong
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Lulu Fan
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Kaifang Wang
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Qing Xu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Baiyan Chen
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Jianxin Dong
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Yanan Shi
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Zhengyan Wang
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - ShiQi Wang
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Xiaoli Zhuang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Qi Li
- Department of Anesthesiology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Feihong Lin
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Xinyu Yao
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - WenBo Zhang
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Chang Kong
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
| | - Rui Zhang
- Department of Anesthesiology, Affiliated Hospital of Weifang Medical University, Weifang, China.
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
| | - Dayun Feng
- Department of neurosurgery, Tangdu hospital, Fourth Military Medical University, Xi'an, China.
| | - Xiaoyong Zhao
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
- Department of Anesthesiology, Affiliated Hospital of Weifang Medical University, Weifang, China.
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, China.
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Yiangou A, Mollan SP, Sinclair AJ. Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms. Nat Rev Neurol 2023; 19:769-785. [PMID: 37957260 DOI: 10.1038/s41582-023-00893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. Previously, IIH was considered a disease exclusively affecting the neuro-ophthalmic axis, characterized by raised intracranial pressure, headache and papilloedema, and resulting in the risk of severe and permanent visual loss and life-changing disabling headaches. Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. The incidence is rapidly rising and parallels the escalating worldwide obesity rates. Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. Adipose distribution in people with IIH, like that in other metabolic diseases, is preferentially centripetal and is associated with changes in intracranial pressure. Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion. Knowledge of these additional disease features is driving research into novel therapeutic targets and altering the approach to multidisciplinary care.
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Affiliation(s)
- Andreas Yiangou
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan P Mollan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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Parsons AD, Sanscrainte C, Leone A, Griepp DW, Rahme R. Dialysis Disequilibrium Syndrome and Intracranial Pressure Fluctuations in Neurosurgical Patients Undergoing Renal Replacement Therapy: Systematic Review and Pooled Analysis. World Neurosurg 2023; 170:2-6. [PMID: 36494069 DOI: 10.1016/j.wneu.2022.11.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dialysis disequilibrium syndrome is a rare, well-known, potentially life-threatening complication of renal replacement therapy (RRT), often involving cerebral edema and increased intracranial pressure (ICP). However, the impact of RRT on ICP and rate of dialysis disequilibrium syndrome in neurosurgical patients have not been systematically assessed. METHODS In February 2022, a systematic review following PRISMA guidelines was conducted using various combinations of 9 keywords in the MEDLINE database. Eleven papers were selected. Individual patient data were extracted, pooled, and analyzed. RESULTS Fifty-eight patients, 44 men and 14 women with a mean age of 48 years (6-78 years), were analyzed. Neurosurgical conditions included the following: spontaneous intracranial hemorrhage (n = 27), traumatic brain injury (n = 16), ischemic stroke/anoxic brain injury (n = 6), intracranial tumor (n = 6), and others (n = 3). Neurosurgical interventions included the following: craniotomy/craniectomy (n = 23), external ventricular drain or ICP monitor placement (n = 16), and burr hole or twist drill craniostomy (n = 4). Intermittent dialysis was used in 33 patients, continuous RRT in 20, and a combination thereof in 4. During RRT, ICP increased in 35 patients (60.3%), remained unchanged in 20, and decreased in 3. Thirty-four patients (65.4%) died. Intermittent dialysis was associated with increased ICP (73% vs. 37.5%, P = 0.01) and mortality (75% vs. 39.1%, P = 0.01). CONCLUSIONS In neurosurgical patients, ICP increases during RRT are common, affecting up to 60%, and potentially life-threatening, with mortality rates as high as 65%. The use of a continuous rather than intermittent RRT technique may reduce the risk of this complication. Prospective studies are warranted.
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Affiliation(s)
- Andrew D Parsons
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA
| | | | - Augusto Leone
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA; Klinik für Neurochirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Daniel W Griepp
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA; Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| | - Ralph Rahme
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA; CUNY School of Medicine, New York, New York, USA.
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Cardiovascular Response to Intravenous Glucose Injection during Hemodialysis with Assessment of Entropy Alterations. Nutrients 2022; 14:nu14245362. [PMID: 36558521 PMCID: PMC9787561 DOI: 10.3390/nu14245362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The quality of autonomic blood pressure (BP) control can be assessed by the entropy of serial BP data. The aim of this study was to evaluate the effect of hemodialysis (HD) and glucose infusion (GI) on amplitude aware permutation entropy (AAPE) of hemodynamic variables during HD in chronic kidney disease patients with and without type-2 diabetes mellitus (DM). METHODS Twenty-one patients without DM (NDO) and ten with DM were studied. Thirty minutes after the start of HD, a 40% glucose solution was administered. Hemodynamic data were extracted from continuous recordings using the Portapres® system. RESULTS AAPE decreased during HD in all patients and all hemodynamic signals with the exception of AAPE of mean and diastolic BP in DM patients. GI led to an increase in AAPE for cardiac output in all patients, while AAPE for heart rate and ejection time increased only in DM studies, and AAPE for systolic, diastolic, and mean arterial pressure, as well as total peripheral resistance, increased only in NDO patients. CONCLUSIONS The reduction in entropy during HD indicates impaired autonomic control in response to external perturbations. This state is partially reversed by the infusion of glucose with differences in central and peripheral responsiveness in DM and NDO patients.
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Petitclerc T, Mercadal L. Automated adjustment of dialysate sodium by the hemodialysis monitor: Rationale, implementation, and clinical benefits. Semin Dial 2022; 36:184-192. [PMID: 36461085 DOI: 10.1111/sdi.13132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022]
Abstract
Prescribing dialysate sodium is the responsibility of the physician, but there are currently no clear guidelines for this prescription. Furthermore, there is quite frequently a significant difference between prescribed and measured dialysate sodium. Several arguments, both theoretical and experimental, suggest that dialysate sodium should be adjusted individually in such a way as to result in a decreasing sodium profile that takes into account the patient's predialytic natremia. The generalization in clinical routine of this strategy requires the integration into the hemodialysis monitor of software making the machine capable to automatically adjust the dialysate sodium at each session. The only three such softwares that have been integrated into hemodialysis machines for routine clinical use are discussed. All three work with conductivity measurements as a surrogate for sodium concentrations. Although there are only a few publications on the use of these softwares in clinical practice, they appear to result in improved intradialytic tolerance to the dialysis treatment, better control of hypertension, and reduced thirst, leading to decreased interdialytic weight gain.
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Affiliation(s)
| | - Lucile Mercadal
- Department of Nephrology Pitié‐Salpêtrière Hospital, Assistance Publique ‐ Hôpitaux de Paris Paris France
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Zwiech R, Bruzda-Zwiech A, Balcerczak E, Szczepańska J, Krygier A, Małachowska B, Michałek D, Szmajda-Krygier D. A potential link between AQP3 and SLC14A1 gene expression level and clinical parameters of maintenance hemodialysis patients. BMC Nephrol 2022; 23:297. [PMID: 36038817 PMCID: PMC9426232 DOI: 10.1186/s12882-022-02922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The transport of water and urea through the erythrocyte membrane is facilitated by aquaporins such as aquaglyceroporin (AQP3), and type B urea transporters (UT-B). As they may play an important role in osmotic balance of maintenance hemodialysis (HD) patients, the aim of the present study was to determine whether any relationship exists between the expression of their genes and the biochemical / clinical parameters in HD patients. Methods AQP3 and UT-B (SLC14A1) gene expression was evaluated using RT-qPCR analysis in 76 HD patients and 35 participants with no kidney failure. Results The HD group demonstrated significantly higher median expression of AQP3 and UT-B (Z = 2.16; P = 0.03 and Z = 8.82; p < 0.0001, respectively) than controls. AQP3 negatively correlated with pre-dialysis urea serum concentration (R = -0.22; P = 0.049) and sodium gradient (R = -0.31; P = 0.04); however, no significant UT-B correlations were observed. Regarding the cause of end-stage kidney disease, AQP3 expression positively correlated with erythropoietin dosages in the chronic glomerulonephritis (GN) subgroup (R = 0.6; P = 0.003), but negatively in the diabetic nephropathy subgroup (R = -0.59; P = 0.004). UT-B positively correlated with inter-dialytic weight gain% in the GN subgroup (R = 0.47; P = 0.03). Conclusion Maintenance hemodialysis seems significantly modify AQP3 and UT-B expression but their link to clinical and biochemical parameters needs further large-scale evaluation.
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Affiliation(s)
- Rafał Zwiech
- Dialysis Department, Norbert Barlicki Memorial Teaching Hospital, No. 1, Lodz, Poland
| | | | - Ewa Balcerczak
- Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Joanna Szczepańska
- Department of Pediatric Dentistry, Medical University of Lodz, Lodz, Poland
| | - Adrian Krygier
- Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Beata Małachowska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Dominika Michałek
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Dagmara Szmajda-Krygier
- Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland.
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11
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Rickli C, Kalva DC, Frigieri GH, Schuinski AFM, Mascarenhas S, Vellosa JCR. Relationship between dialysis quality and brain compliance in patients with end-stage renal disease (ESRD): a cross-sectional study. SAO PAULO MED J 2022; 140:398-405. [PMID: 35507989 PMCID: PMC9671244 DOI: 10.1590/1516-3180.2021.0117.r1.14092021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The high number of patients with end-stage kidney disease (ESRD) on hemodialysis makes it necessary to conduct studies aimed at improving their quality of life. OBJECTIVES To evaluate brain compliance, using the Brain4care method for intracranial pressure (ICP) monitoring, among patients with ESRD before and at the end of the hemodialysis session, and to correlate ICP with the dialysis quality index (Kt/V). DESIGN AND SETTING Cross-sectional study conducted at a renal replacement therapy center in Brazil. METHODS Sixty volunteers who were undergoing hemodialysis three times a week were included in this study. Brain compliance was assessed before and after hemodialysis using the noninvasive Brain4care method and intracranial pressure wave morphology was analyzed. RESULTS Among these 60 ESRD volunteers, 17 (28%) presented altered brain compliance before hemodialysis. After hemodialysis, 12 (20%) exhibited normalization of brain compliance. Moreover, 10 (83%) of the 12 patients whose post-dialysis brain compliance became normalized were seen to present good-quality dialysis, as confirmed by Kt/V > 1.2. CONCLUSIONS It can be suggested that changes to cerebral compliance in individuals with ESRD occur frequently and that a good-quality hemodialysis session (Kt/V > 1.2) may be effective for normalizing the patient's cerebral compliance.
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Affiliation(s)
- Cristiane Rickli
- PhD. Professor, Centro Universitário Integrado, Campo Mourão (PR), Brazil.
| | - Danielle Cristyane Kalva
- PhD. Professor, Biological and Health Sciences Division, Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil.
| | - Gustavo Henrique Frigieri
- PhD. Research Coordinator, Braincare Desenvolvimento e Inovação Tecnológica S.A., São Carlos (SP), Brazil.
| | - Adriana Fatima Menegat Schuinski
- MD. Professor, Biological and Health Sciences Division, Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil.
| | - Sérgio Mascarenhas
- PhD. Founder, Braincare Desenvolvimento e Inovação Tecnológica S.A., São Carlos (SP), Brazil.
| | - José Carlos Rebuglio Vellosa
- PhD. Associate Professor, Biological and Health Sciences Division, Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa (PR), Brazil.
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12
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Bellamkonda A, Chowdhury T, Shankar M, Gousy N. Dialysis Disequilibrium Syndrome: A Red Flag to Check Post Hemodialysis. Cureus 2022; 14:e24619. [PMID: 35651473 PMCID: PMC9138484 DOI: 10.7759/cureus.24619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/06/2022] Open
Abstract
Dialysis disequilibrium syndrome (DDS) is a neurological disorder with varying severity which is primarily caused by the rapid removal of urea during hemodialysis, which was first described in the literature in 1962. Common risk factors are extreme age, high blood urea nitrogen, sudden change in dialysis regimen, presence of other conditions causing cerebral edema, preexisting neurological diseases, and increased permeability of the blood-brain barrier. Understanding these risk factors and preventing the syndrome is crucial as no specific treatment guideline has been established yet. In this case report, we are presenting a case with a conglomeration of clinical attributes suggesting DDS.
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13
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DeepBiomarker: Identifying Important Lab Tests from Electronic Medical Records for the Prediction of Suicide-Related Events among PTSD Patients. J Pers Med 2022; 12:jpm12040524. [PMID: 35455640 PMCID: PMC9025406 DOI: 10.3390/jpm12040524] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Identifying patients with high risk of suicide is critical for suicide prevention. We examined lab tests together with medication use and diagnosis from electronic medical records (EMR) data for prediction of suicide-related events (SREs; suicidal ideations, attempts and deaths) in post-traumatic stress disorder (PTSD) patients, a population with a high risk of suicide. We developed DeepBiomarker, a deep-learning model through augmenting the data, including lab tests, and integrating contribution analysis for key factor identification. We applied DeepBiomarker to analyze EMR data of 38,807 PTSD patients from the University of Pittsburgh Medical Center. Our model predicted whether a patient would have an SRE within the following 3 months with an area under curve score of 0.930. Through contribution analysis, we identified important lab tests for suicide prediction. These identified factors imply that the regulation of the immune system, respiratory system, cardiovascular system, and gut microbiome were involved in shaping the pathophysiological pathways promoting depression and suicidal risks in PTSD patients. Our results showed that abnormal lab tests combined with medication use and diagnosis could facilitate predicting SRE risk. Moreover, this may imply beneficial effects for suicide prevention by treating comorbidities associated with these biomarkers.
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14
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Dialysis Disequilibrium: Is Acidosis More Important than Urea? Case Rep Nephrol 2022; 2022:4964033. [PMID: 35242392 PMCID: PMC8888092 DOI: 10.1155/2022/4964033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Dialysis disequilibrium syndrome is a severe complication associated with dialysis treatment. Manifestations may range from mild such as headache to severe such as seizures and coma. Risk factors for development include initial dialysis treatment, uraemia, metabolic acidosis, and extremes of age. We report a case of dialysis disequilibrium in a patient with a failing kidney transplant secondary to the recurrence of IgA nephropathy. Disturbance in cognition and neurologic functioning occurred six hours after the completion of initiation of intermittent haemodialysis. During two sessions of intermittent haemodialysis of 3 and 4 hours, urea was reduced by 21.9 and 17.2 mmol/L and measured serum osmolality was reduced by 25 and 14 mOsm/kg, respectively. Subsequent admission to the intensive care unit and initiation of continuous renal replacement therapy for 48 hours resulted in complete resolution of symptoms. In this case report, we discuss atypical clinical and radiologic features of dialysis disequilibrium occurring with modest reductions in urea and serum osmolality.
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15
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Liu KH, Lee SH, Lin WR, Tsai YS, Sung JM. Recovery of severe dialysis disequilibrium syndrome with uncal herniation following therapy with mannitol, hyperventilation and hypertonic saline. Clin Kidney J 2022; 15:165-167. [PMID: 35035947 PMCID: PMC8757411 DOI: 10.1093/ckj/sfab165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 11/25/2022] Open
Abstract
Dialysis disequilibrium syndrome (DDS) is a rare complication of dialysis, especially with the general application of preventive strategies. Severe DDS with brain herniation is believed to be fatal. We present a patient presenting with bilateral uncal herniation after receiving two dialysis sessions with low-efficiency settings. Serial brain magnetic resonance imaging studies showed the temporal evolution of DDS-induced cerebral edema. With aggressive treatment of hypertonic saline and mannitol, the patient made a remarkable recovery. This case highlights that we should be cautious about this severe complication of dialysis even with preventive strategies, and recovery is possible with prompt recognition and treatment.
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Affiliation(s)
- Kuan-Hung Liu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shao-Hua Lee
- Department of Diagnostic Radiology, Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Wei-Ren Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, Yun-Lin County, Taiwan
| | - Yau-Sheng Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Center for Clinical Medicine Research, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Junne-Ming Sung
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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16
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Xu D, Yang A, Ren R, Shan Z, Li Y, Tan J. Vitamin K2 as a potential therapeutic candidate for the prevention of muscle cramps in hemodialysis patients: A prospective multicenter, randomized, controlled crossover pilot trial. Nutrition 2022; 97:111608. [DOI: 10.1016/j.nut.2022.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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17
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Canaud B, Stephens MP, Nikam M, Etter M, Collins A. Multitargeted interventions to reduce dialysis-induced systemic stress. Clin Kidney J 2021; 14:i72-i84. [PMID: 34987787 PMCID: PMC8711765 DOI: 10.1093/ckj/sfab192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Hemodialysis (HD) is a life-sustaining therapy as well as an intermittent and repetitive stress condition for the patient. In ridding the blood of unwanted substances and excess fluid from the blood, the extracorporeal procedure simultaneously induces persistent physiological changes that adversely affect several organs. Dialysis patients experience this systemic stress condition usually thrice weekly and sometimes more frequently depending on the treatment schedule. Dialysis-induced systemic stress results from multifactorial components that include treatment schedule (i.e. modality, treatment time), hemodynamic management (i.e. ultrafiltration, weight loss), intensity of solute fluxes, osmotic and electrolytic shifts and interaction of blood with components of the extracorporeal circuit. Intradialytic morbidity (i.e. hypovolemia, intradialytic hypotension, hypoxia) is the clinical expression of this systemic stress that may act as a disease modifier, resulting in multiorgan injury and long-term morbidity. Thus, while lifesaving, HD exposes the patient to several systemic stressors, both hemodynamic and non-hemodynamic in origin. In addition, a combination of cardiocirculatory stress, greatly conditioned by the switch from hypervolemia to hypovolemia, hypoxemia and electrolyte changes may create pro-arrhythmogenic conditions. Moreover, contact of blood with components of the extracorporeal circuit directly activate circulating cells (i.e. macrophages-monocytes or platelets) and protein systems (i.e. coagulation, complement, contact phase kallikrein-kinin system), leading to induction of pro-inflammatory cytokines and resulting in chronic low-grade inflammation, further contributing to poor outcomes. The multifactorial, repetitive HD-induced stress that globally reduces tissue perfusion and oxygenation could have deleterious long-term consequences on the functionality of vital organs such as heart, brain, liver and kidney. In this article, we summarize the multisystemic pathophysiological consequences of the main circulatory stress factors. Strategies to mitigate their effects to provide more cardioprotective and personalized dialytic therapies are proposed to reduce the systemic burden of HD.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, Montpellier, France
- Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - Melanie P Stephens
- MSL & Medical Strategies for Innovative Therapies, Fresenius Medical Care, Waltham, MA, USA
| | - Milind Nikam
- Global Medical Office, Fresenius Medical Care, Hong Kong
| | - Michael Etter
- Global Medical Office, Fresenius Medical Care, Hong Kong
| | - Allan Collins
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
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18
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Abstract
Uremic encephalopathy encompasses a wide range of central nervous system abnormalities associated with poor kidney function occurring with either progressive chronic kidney disease or acute kidney injury. The syndrome is likely caused by retention of uremic solutes, alterations in hormonal metabolism, changes in electrolyte and acid-base homeostasis, as well as changes in vascular reactivity, blood-brain barrier transport, and inflammation. There are no defining clinical, laboratory, or imaging findings, and the diagnosis is often made retrospectively when symptoms improve after dialysis or transplantation. The diagnosis is also made difficult because of the many confounding and overlapping conditions seen in patients with chronic kidney disease and acute kidney injury. Thus, institution of kidney replacement therapy should be considered as a trial to improve symptoms in the right clinical context. Neurological symptoms that do not improve after improvement in clearance should prompt a search for other explanations. Further knowledge linking possible uremic retention solutes with neurological symptoms is needed to better understand this syndrome as well as to develop more tailored treatments that aim to improve cognitive function.
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19
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Wirawan C, Sumada IK, Yuliani D, Wiratmi NKC, Sukiandra R. Dialysis Disequilibrium Syndrome Induced Seizure Following Hemodialysis. Cureus 2021; 13:e17821. [PMID: 34660031 PMCID: PMC8500255 DOI: 10.7759/cureus.17821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Dialysis Disequilibrium Syndrome (DDS) is a set of neurological signs and symptoms that can occur during or following dialysis. Osmotic fluid gradient alteration caused by the dialysis process can cause cerebral edema. This process relates to the changes of high gradient urea in both the blood and central nervous system (CNS), which can modulate extracellular fluid influx into brain cells. A 77-year-old woman presented with chronic kidney disease (CKD) and hypertension with headache and tonic-clonic seizure following initial hemodialysis. In this case, we identified that adjustment to the hemodialysis prescriptions such as duration, blood flow rate, and target reduction of blood urea would be the key to avoid seizure following hemodialysis.
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Affiliation(s)
- Chandra Wirawan
- Department of Neurology, Wangaya General Hospital, Bali, IDN
| | - I Ketut Sumada
- Department of Neurology, Wangaya General Hospital, Bali, IDN
| | - Desie Yuliani
- Department of Neurology, Wangaya General Hospital, Bali, IDN
| | | | - Riki Sukiandra
- Department of Neurology, Arifin Achmad General Hospital, Riau, IDN
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20
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Takkavatakarn K, Kittiskulnam P, Tiranathanagul K, Katavetin P, Wongyai N, Mahatanan N, Tungsanga K, Eiam-Ong S, Praditpornsilpa K, Susantitaphong P. The role of once-weekly online hemodiafiltration with low protein diet for initiation of renal replacement therapy: A case series. Int J Artif Organs 2021; 44:900-905. [PMID: 34596447 DOI: 10.1177/03913988211049815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incremental hemodialysis (HD) has become an exciting approach according to the recognition of the importance of preserving residual kidney function (RKF). However, not all incident HD patients are suitable for this approach, particularly once-weekly HD. This is the first study which reported the effectiveness of once-weekly online-hemodiafiltration (OL-HDF) plus low protein diet (LPD) in incident HD patients. All stage 5 CKD patients who had chosen HD as their treatment modality at the HD center of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, with RKF ⩾ 3 mL/min calculated by renal clearance of urea and urine output ⩾ 800 mL/day, started the treatment with once-weekly OL-HDF. Dietitians advised patients to consume LPD (0.6-0.8 g/kg/day) on non-dialysis days and a regular protein diet on the dialysis day (1.2 g/kg/day). Eleven incident HD patients were enrolled in the study. The mean RKF and urine volume at baseline were 4.56 ± 2.21 mL/min and 2,019.54 ± 743.73 mL/day, respectively. After 6 and 12 months of follow-up, the mean RKF of the patients who remained in the once-weekly OL-HDF protocol were 3.82 ± 1.68 mL/min and 3.28 ± 0.95 mL/min, respectively. The median duration of once-weekly OL-HDF before transitioning to twice- or thrice-weekly OL-HDF was 7 months (3-24 months). The most common indication for stepping prescription was too low RKF. We reported that dialysis initiation in the university-based center with once-weekly OL-HDF in carefully selected incident HD patients combined with LPD under serial monitoring is practical. Further studies on the clinical benefits of once-weekly OL-HDF are still required.
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Affiliation(s)
- Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Niramon Wongyai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nanta Mahatanan
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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21
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Stahl JL, Whelan RS, Symons JM. Dialysis disequilibrium on CKRT: avoiding the steep slippery slope. Pediatr Nephrol 2021; 36:2697-2702. [PMID: 33835264 DOI: 10.1007/s00467-021-05026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/30/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Current guidelines for initiation of kidney replacement do not include specific recommendations for prescription parameters and monitoring. CASE OUTLINE A 16-year-old girl presented with kidney failure with creatinine of 19.8 mg/dL and BUN of 211 mg/dL. She initiated continuous kidney replacement therapy (CKRT) with clearance of 1,300 mL/min/1.73 m2 which was increased to 1,950 mL/min/1.73 m2 at 17 h of stable therapy. COMPLICATIONS At 31 h of therapy, she developed generalized seizure activity. CT imaging was negative for acute intracranial process, and EEG demonstrated diffuse encephalopathy. CKRT was discontinued, and BUN was noted to be 47 mg/dL at that time (a 79% reduction from presenting BUN). KEY MANAGEMENT POINTS • The potential for development of DDS is not isolated to intermittent hemodialysis and may occur later in presentation. • A decreased clearance rate should be considered in those with risk factors for development of dialysis disequilibrium syndrome (DDS). • Frequent monitoring of BUN/serum osmolality is important to allow for adjustment of the KRT prescription following initiation of therapy. • Additional research is needed to guide risk assessment for DDS and therapeutic timing and goals in the early stages of KRT initiation. • Inclusion of more specific guidelines surrounding DDS would assist in providing important support for nephrologists. LIST OF RELEVANT GUIDELINES KDIGO clinical practice guideline for acute kidney injury [1] Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease [2] The Renal Association Clinical Practice Guideline Acute Kidney Injury (AKI) [3] The Japanese Clinical Practice Guideline for Acute Kidney Injury [4].
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Affiliation(s)
- Jessica L Stahl
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Russell S Whelan
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jordan M Symons
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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22
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Lupuşoru M, Lupuşoru G, Ailincăi I, Frățilă G, Andronesi A, Micu E, Banu M, Costea R, Ismail G. Renal replacement therapy in cancer patients with acute kidney injury (Review). Exp Ther Med 2021; 22:864. [PMID: 34178137 PMCID: PMC8220659 DOI: 10.3892/etm.2021.10296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Cancer patients are at high risk for developing acute kidney injury (AKI), which is associated with increased morbidity and mortality in these patients. Despite the progress made in understanding the pathogenic mechanisms and etiology of AKI in these patients, the main prevention consists of avoiding medication and nephrotoxic agents such as non-steroidal anti-inflammatory drugs, contrast agents used in medical imaging and modulation of chemotherapy regimens; when prophylactic measures are overcome and renal impairment becomes unresponsive to treatment, renal replacement therapy (RRT) is required. There are several methods of RRT that can be utilized for patients with malignancies and acute renal impairment; the choice of treatment being based on the patient characteristics. The aim of this article is to review the literature data regarding the epidemiology and management of AKI in cancer patients, the extracorporeal techniques used, choice of the appropriate therapy and the optimal time of initiation, and also the dose-prognosis relationship.
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Affiliation(s)
- Mircea Lupuşoru
- Department of Physiology 1, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gabriela Lupuşoru
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
- Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ioana Ailincăi
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Georgiana Frățilă
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Andronesi
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
- Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Elena Micu
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
- Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Banu
- Department of Morphology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Costea
- Department of General Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gener Ismail
- Department of Physiology 1, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
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23
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Rickli C, Cosmoski LD, Dos Santos FA, Frigieri GH, Rabelo NN, Schuinski AM, Mascarenhas S, Vellosa JCR. Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD). PLoS One 2021; 16:e0240570. [PMID: 34292964 PMCID: PMC8297761 DOI: 10.1371/journal.pone.0240570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/26/2021] [Indexed: 01/24/2023] Open
Abstract
End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.
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Affiliation(s)
- Cristiane Rickli
- Biological and Health Sciences Division, State University of Ponta Grossa-UEPG, Ponta Grossa-PR, Brazil
| | - Lais Daiene Cosmoski
- Biological and Health Sciences Division, State University of Ponta Grossa-UEPG, Ponta Grossa-PR, Brazil
| | - Fábio André Dos Santos
- Biological and Health Sciences Division, State University of Ponta Grossa-UEPG, Ponta Grossa-PR, Brazil
| | | | | | - Adriana Menegat Schuinski
- Biological and Health Sciences Division, State University of Ponta Grossa-UEPG, Ponta Grossa-PR, Brazil
| | - Sérgio Mascarenhas
- Braincare Desenvolvimento e Inovação Tecnológica S.A., São Carlos-SP, Brazil
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24
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Review of Traditional Chinese Medicines for Common Complications Related to Hemodialysis: An Evidence-Based Perspective. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9953986. [PMID: 34335848 PMCID: PMC8292057 DOI: 10.1155/2021/9953986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022]
Abstract
Renal replacement therapy is an important therapy for prolonging life in end-stage renal disease (ESRD) populations, and, in Taiwan, hemodialysis (HD) is the choice for most patients with ESRD. Although HD is effective for prolonging life, it is sometimes associated with complications that patients and doctors have to cope with every day, such as intradialytic hypotension, dialysis disequilibrium syndrome, and muscle cramps. Traditional Chinese medicine (TCM) is a complementary and alternative therapy that has been recognized for its efficacy in treating a variety of diseases by the World Health Organization. Nowadays, the clinical practice of TCM for HD-related complications has received attention for its effectiveness and safety. In this article, we summarize the TCM viewpoint and different TCM interventions for HD-related complications, such as Chinese herbal medicine, acupuncture, herbal acupoint therapy, auricular acupoints, and moxibustion. In the ESRD population, TCM is able to balance Yin and Yang, prevent cardiovascular accidents, control blood pressure, and relieve pain. More importantly, TCM may also improve common HD-related complications such as uremic symptoms, imbalance of electrolyte and fluid status, insomnia, and malnutrition. The mechanism of TCM is considered related to the regulation of autonomous functions and the activation of biologically active chemical substances. According to the studies noted in this review article, TCM has been proven effective for HD-related complications. However, more well-designed and rigorous research will be necessary to reveal the underlying mechanisms in the future.
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Ghoshal S, Parikh A. Dialysis-Associated Neurovascular Injury (DANI) in Acute Brain Injury: Practical Considerations for Intermittent Dialysis in the Neuro-ICU. Clin J Am Soc Nephrol 2021; 16:1110-1112. [PMID: 33574055 PMCID: PMC8425614 DOI: 10.2215/cjn.15000920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Shivani Ghoshal
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amay Parikh
- Departments of Nephrology and Critical Care, AdventHealth Orlando, Orlando, Florida
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Genena KH, Ahmed S, Szerlip HM, Schwartz JC. Half the V by 120: A practical approach to the prevention of the dialysis disequilibrium syndrome. Hemodial Int 2021; 25:424-432. [PMID: 34145961 DOI: 10.1111/hdi.12938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/03/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Abstract
The dialysis disequilibrium syndrome (DDS) results from osmotic shifts between the blood and the brain compartments. Patients at risk for DDS include those with very elevated blood urea nitrogen, concomitant hypernatremia, metabolic acidosis, and low total body water volumes. By understanding the underlying pathophysiology and applying urea kinetic modeling, it is possible to avoid the occurrence of this disorder. A urea reduction ratio (URR) of no more than 40%-45% over 2 h is recommended for the initial hemodialysis treatment. The relationship between the URR and Kt/V is useful when trying to model the dialysis treatment to a specific URR target. A simplified relationship between Kt/V and URR is provided by the equation: Kt/V = -ln (1 - URR). A URR of 40% is roughly equivalent to a Kt/V of 0.5. The required dialyzer urea clearance to achieve this goal URR in a 120-min treatment can simply be calculated by dividing half the patient's volume of distribution of urea by 120. The blood flow rate and dialyzer mass transfer coefficient (K0 A) required to achieve this clearance can then be plotted on a nomogram. Other methods to reduce the risk of DDS are reviewed, including the use of continuous renal replacement therapy.
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Affiliation(s)
- Kareem H Genena
- Nephrology Division, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Harold M Szerlip
- Nephrology Division, Baylor University Medical Center, Dallas, Texas, USA
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Sanada H, Yamaguchi K, Miyake T. Dialysis Disequilibrium Syndrome in a Patient With Acute Kidney Injury on Chronic Kidney Disease. Cureus 2021; 13:e15608. [PMID: 34131551 PMCID: PMC8196242 DOI: 10.7759/cureus.15608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dialysis disequilibrium syndrome (DDS) is a neurological complication that has been known to occur after hemodialysis (HD). In recent years, the prevalence of DDS has been low as the symptoms are widely recognized; hence, preventive therapies, such as the slow and gentle procedure for HD, are often administered before starting dialysis. However, once DDS occurs, it may cause seizures, coma, and even death in severe cases. Since there has been no established treatment, recognizing risk factors and preventing the syndrome is important. A 76-year-old man was admitted to our hospital due to exacerbation of chronic heart failure. He also had a history of chronic kidney disease and had consulted with his home doctor about the preparation for HD a month before admission. After treatment with diuretics, the symptoms ameliorated, but he experienced presyncope and malaise. Laboratory tests revealed acute anemia and a decrease in renal function. Upper gastrointestinal endoscopy revealed active bleeding from a gastric ulcer, which was successfully stopped. However, his consciousness deteriorated because of uremia; hence, HD was initiated. We used a cellulose triacetate membrane with a surface area of 1.3 m2 and maintained a dialysate flow rate of 500 ml/min with a blood flow rate of 120 ml/min. Four hours after starting HD, he suddenly developed generalized tonic convulsions. The dialysis was immediately stopped, and the patient was transferred to an intensive care unit. A computed tomography scan of the head showed mild edematous change of the brain, and laboratory tests also revealed a rapid decrease of urea nitrogen. We rationalized that he might have developed DDS. After injection of levetiracetam for the treatment of seizures, we initiated continuous hemodiafiltration as renal replacement therapy. Fortunately, his consciousness gradually improved, and he was completely alert on day 18 after admission. With reference to our current report, DDS can occur even following acute kidney injury, as the progression rate of the injury and accumulation of blood urea may not correlate with the risk of the syndrome.
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Affiliation(s)
- Hajime Sanada
- Division of Nephrology and Rheumatology, Kouseiren Takaoka Hospital, Takaoka, JPN
| | - Kaori Yamaguchi
- Division of Nephrology and Rheumatology, Kouseiren Takaoka Hospital, Takaoka, JPN
| | - Taito Miyake
- Division of Nephrology and Rheumatology, Kouseiren Takaoka Hospital, Takaoka, JPN
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YILMAZ DA, YILDIRIM MS, YILDIZ M, OKYAR G. CENTRAL NERVOUS SYSTEM RESPONSE TO CHRONIC KIDNEY DISEASE. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.917658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Due to the aging of the human population, the prevalence of chronic diseases such as chronic kidney disease (CKD) is increasing every year. Chronic kidney disease is a general term that refers to heterogeneous disorders that affect kidney structure and function. Decrease in glomerular filtration can be defined as chronic and progressive deterioration in fluid-solute balance, metabolic and endocrine functions of the kidney. CKD often affects the elderly. With the advancement of age, some structural and functional changes occur in the kidneys. Therefore, the number of patients suffering from mild and moderate CKD is expected to increase in the future.CKD leads to the deep metabolic and hemodynamic changes that damage other organs, such as the heart and brain. CNS abnormalities and cognitive deficits progress with the severity of CBS and occurs mostly among hemodialysis patients. It also has great socio-economic effects on individuals. Since symptoms of CKD are not often found in patients, early recognition of risk factors is the main point. For this reason, it is necessary to identify possible protective and preventive treatments to be applied in at-risk groups and to examine these mechanisms for the treatment of the disease. This review provides available information on the relevant mechanisms.
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Florea B, Orasan R, Budurea C, Patiu I, Demeny H, Bondor CI, Vécsei L, Beniczky S. EEG spectral changes induced by hemodialysis. Clin Neurophysiol Pract 2021; 6:146-148. [PMID: 34013098 PMCID: PMC8114056 DOI: 10.1016/j.cnp.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the EEG spectral changes induced during hemodialysis in patients with chronic kidney disease (CKD), and to identify the risk factors associated with changes in the Central Nervous System (CNS) during hemodialysis. Paradoxical neurological deterioration at the end of hemodialysis sessions, known as dialysis disequilibrium syndrome (DDS) has been described, but previous studies on EEG spectral changes during hemodialysis were controversial. METHODS We performed quantitative EEG spectral analysis in 56 consecutive patients who underwent hemodialysis. We compared EEG at the start and at the end of the hemodialysis, and we correlated the spectral changes with the biochemical and clinical characteristics of the patients, using multivariate analysis. RESULTS At the end of hemodialysis sessions, we found a significant increase in total EEG power, relative power in delta frequency band and the ratio of delta-theta/alpha-beta power. EEG spectral changes were associated with younger age, recent start of hemodialysis therapy, level of uremia and lower level of glycaemia. CONCLUSIONS Quantitative EEG spectral analysis showed that hemodialysis induced slowing of the EEG background activity. These changes were associated with risk factors of DDS. SIGNIFICANCE EEG spectral changes are potential biomarkers for monitoring CNS function during hemodialysis.
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Affiliation(s)
- Bogdan Florea
- Epilepsy and EEG Monitoring Center Cluj-Napoca, Romania
- Department of Neurology, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, Hungary
| | | | | | - Ioan Patiu
- Nefromed Dialysis Centers Cluj-Napoca, Romania
| | - Helga Demeny
- Department of Physiology, USAMV Cluj-Napoca, Cluj-Napoca, Romania
| | - Cosmina Ioana Bondor
- Department of Medical Informatics and Biostatistics, Statistics, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - László Vécsei
- Department of Neurology, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, Hungary
| | - Sándor Beniczky
- Department of Neurology, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, Hungary
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Abstract
This article introduces the basic concepts of intracranial physiology and pressure dynamics. It also includes discussion of signs and symptoms and examination and radiographic findings of patients with acute cerebral herniation as a result of increased as well as decreased intracranial pressure. Current best practices regarding medical and surgical treatments and approaches to management of intracranial hypertension as well as future directions are reviewed. Lastly, there is discussion of some of the implications of critical medical illness (sepsis, liver failure, and renal failure) and treatments thereof on causation or worsening of cerebral edema, intracranial hypertension, and cerebral herniation.
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Affiliation(s)
- Aleksey Tadevosyan
- Department of Neurology, Tufts University School of Medicine, Beth Israel Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
| | - Joshua Kornbluth
- Department of Neurology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Box#314, Boston, MA 02111, USA
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Chanliau J, Durand PY. Lowering dialysis sessions duration may be dangerous. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i1.60263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysis session in less duration - either to give a better quality of life for the patient or to optimize the organization the dialysis institution - may have bad repercussions on the quality of the treatment and therefore the quality of life of the patient.
According to the result of the publications listed in this work, we conclude that it is necessary to perform either longer sessions or more frequent treatments to limit the interval time between two sessions.
As this is difficult to perform by the providers, we recommend to develop home dialysis to obtain the best result.
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Ghoshal S, Freedman BI. Renal Replacement Therapy and Dialysis-associated Neurovascular Injury (DANI) in the Neuro ICU: a Review of Pathophysiology and Preventative Options. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-020-00661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sutar R, Atlani MK, Chaudhary P. Antipsychotics and hemodialysis: A systematic review. Asian J Psychiatr 2021; 55:102484. [PMID: 33341539 DOI: 10.1016/j.ajp.2020.102484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Antipsychotics play a crucial role in the management of behavioral problems in patients undergoing hemodialysis. Oral and injectable antipsychotics are routinely prescribed to control emergent delirium or exacerbation of previous psychiatric symptoms. However scanty literature is available on the pharmacokinetics of antipsychotics in such patients. Avoiding amisulpride and warning against increasing the dosage in renal failure is the only recommendation by drug manufacturers and clinical guidelines. Hemodialysis affects the volume of distribution (Vd) and blood levels of antipsychotics in a complex manner. It is hence difficult to equate data on renal failure with hemodialysis to reliably predict the treatment response. METHOD We systematically analyzed online data from 1981 to 2019 on the use of antipsychotics in hemodialysis. The outcome was defined as the safety and efficacy of AP, measured in terms of adverse effects and relapse of existing or new onset of behavioral symptoms in Hemodialysis. RESULTS The data from 182 studies revealed that only 14 case reports and 1 case series met the review criteria. Oral Risperidone, Clozapine, Aripiprazole, Ziprasidone, Haloperidol, and Long-acting Risperidone, Flupenthixol, and Paliperidone were the antipsychotics studied in terms of pharmacokinetics during hemodialysis. AP levels in the blood were found to be unaffected in two studies during HD while the other two studies recommended scheduling of AP regimen w.r.t HD session. Six reports mentioned exacerbation of pre-existing psychiatric ailments in patients undergoing HD, the most common being schizophrenia. CONCLUSION Findings of the review reveals modest evidence favoring multiple dosing regimens of oral aripiprazole, ziprasidone, olanzapine, and risperidone. Long-acting risperidone and paliperidone are well tolerated and half of the conventional dose may be effective in the case of paliperidone. Though CYP-3A4 remains relatively and transiently unaltered during hemodialysis, none of the antipsychotics are compromised in HD. While selecting an AP during HD, one has to consider the protein binding, clearance by dialysis, duration of an HD session, route of administration of AP, and impaired bowel absorption in HD.
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Affiliation(s)
- Roshan Sutar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, India.
| | - Mahendra Kumar Atlani
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India.
| | - Pooja Chaudhary
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, India.
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Elzouki AN, Habas E, Habas A, Elgamal M, Shraim B, Moursi M, Ibrahim A, Danjuma M. Common complications of hemodialysis: A clinical review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2021. [DOI: 10.4103/ijmbs.ijmbs_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tinawi M, Bastani B. A mathematical approach to severe hyponatremia and hypernatremia in renal replacement therapies. Semin Dial 2020; 34:42-50. [PMID: 33063373 DOI: 10.1111/sdi.12918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Severe dysnatremias are perplexing problems in patients undergoing renal replacement therapy on a chronic or acute basis. The ability to manipulate sodium concentration in the dialysate or replacement solutions is limited. Compounding dialysate or replacement fluids to alter sodium concentration could result in errors. Rapid correction of hyponatremia or hypernatremia due to equilibrium with dialysate or replacement solutions could lead to osmotic demyelination syndrome or cerebral edema respectively. Continuous renal replacement therapy is the preferred dialysis modality in patients with severe dysnatremias. In this article, we present simple formulas to determine the rate of hypotonic or hypertonic solutions needed to mitigate rapid correction of dysnatremias. These formulas can be used readily by the clinician at bedside.
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Affiliation(s)
| | - Bahar Bastani
- Division of Nephrology, Saint Louis University Health Sciences Center, St. Louis, MO, USA
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Sprick JD, Nocera JR, Hajjar I, O'Neill WC, Bailey J, Park J. Cerebral blood flow regulation in end-stage kidney disease. Am J Physiol Renal Physiol 2020; 319:F782-F791. [PMID: 32985235 DOI: 10.1152/ajprenal.00438.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or "stunning." Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO2 may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.
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Affiliation(s)
- Justin D Sprick
- Division of Renal Medicine, Department of Medicine, Emory University Department of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Joe R Nocera
- Department of Veterans Affairs Health Care System, Decatur, Georgia.,Center for Visual and Neurocognitive Rehabilitation, Department of Veterans Affairs Health Care System, Decatur, Georgia.,Departments of Neurology and Rehabilitation Medicine, Emory University Department of Medicine, Atlanta, Georgia
| | - Ihab Hajjar
- Department of Neurology, Emory University Department of Medicine, Atlanta, Georgia
| | - W Charles O'Neill
- Division of Renal Medicine, Department of Medicine, Emory University Department of Medicine, Atlanta, Georgia
| | - James Bailey
- Division of Renal Medicine, Department of Medicine, Emory University Department of Medicine, Atlanta, Georgia
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University Department of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia.,Center for Visual and Neurocognitive Rehabilitation, Department of Veterans Affairs Health Care System, Decatur, Georgia
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Dialysis Disequilibrium Syndrome and Cerebellar Herniation with Successful Reversal Using Mannitol. Case Rep Nephrol 2020; 2020:8850850. [PMID: 32908738 PMCID: PMC7468602 DOI: 10.1155/2020/8850850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Dialysis disequilibrium syndrome (DDS) is a morbid but rare complication of dialysis. Feared sequalae of this diagnosis are brain herniation and death. This report presents a patient who was diagnosed with DDS with subsequent tonsillar herniation shown on imaging with complete resolution of clinical signs and symptoms, as well as imaging findings of herniation after prompt initiation of intravenous mannitol. This is the first known case of reversal and survival of DDS-induced tonsillar herniation using mannitol.
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Redant S, De Bels D, Massaut J, Barglazan D, Lebitasy PM, Honoré PM. Feasibility of Citrate Dialysis in Hyponatremia: A Case Series. Blood Purif 2020; 50:174-179. [PMID: 32640446 DOI: 10.1159/000509024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Correcting hyponatremia too quickly can lead to osmotic demyelination syndrome. During citrate dialysis, a significant sodium load is brought to the prefilter. We reviewed the impact of this sodium load on the evolution of sodium levels in patients undergoing continuous renal replacement therapy with citrate anticoagulation. MATERIALS AND METHODS The medical records of 5 patients with hyponatremia who received dialysis with citrate anticoagulation, over a 10-year period, were reviewed. The sodium of the dialysate and of the reinjection fluid was adapted according to the serum sodium level recommended by the guidelines of the time. Data from the first 24 h after initiation of dialysis was evaluated. RESULTS The difference in serum sodium levels between day 1 and day 2 was statistically significant, with a rise of 7.8 ± 3.7 mmol/L. DISCUSSION The mean serum sodium increase in our series of patients did not exceed the increase of 10-12 mEq/L/day permitted by the guidelines. The excess sodium was absorbed by the filter. CONCLUSION In this small series of patients, with adjustment of the sodium concentration of dialysate and reinjection fluid, the use of citrate was found to be safe.
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Affiliation(s)
- Sebastien Redant
- ICU Department, Brugmann University Hospital, Brussels, Belgium,
| | - David De Bels
- ICU Department, Brugmann University Hospital, Brussels, Belgium
| | - Jacques Massaut
- ICU Department, Brugmann University Hospital, Brussels, Belgium
| | - Dragos Barglazan
- Clinical Biology Laboratory, Brugmann University Hospital, Brussels, Belgium
| | - Precieux M Lebitasy
- Clinical Biology Laboratory, Brugmann University Hospital, Brussels, Belgium
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