Dialysis Disequilibrium Syndrome: A Red Flag to Check Post Hemodialysis

This chapter reports a case where a change in mentation from baseline has been seen after a few sessions of HD in a patient in whom new dialysis was initiated. Severe dialysis disequilibrium syndrome (DDS) is an increasingly rare complication following the initiation of dialysis treatment. The clinical syndrome is defined by neurological symptoms occurring in close association with haemodialysis and can range from very mild, such that they go unnoticed, to severe. We report a 78-year-old African American female with a past medical history of hypertension and stage 5 chronic kidney disease was referred to ED from the surgery clinic for hypertensive urgency before surgery for dialysis access. Extreme age, high blood urea nitrogen, abrupt dialysis regimen changes, the existence of additional disorders causing cerebral edema, neurological diseases that already exist, and increased blood-brain barrier permeability are common risk factors. As there are now no clear treatment guidelines, it is imperative to comprehend these risk factors and take preventative measures to avoid the syndrome. Due to the rarity of DDS, there has not been any treatment protocol to date, however, supportive steps to manage the symptoms of DDS are suggested.