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Dialysis Disequilibrium Syndrome

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21. Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury Full Text available with Trip Pro

Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT (...) and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

2017 Case reports in critical care

22. Bispectral-Electroencephalography (EEG) in First Time Hemodialysis

: Medical University of Graz Information provided by (Responsible Party): Ashraf Dahaba, MD, Medical University of Graz Study Details Study Description Go to Brief Summary: The severity of minimal dialysis disequilibrium syndrome (DDS) is currently detected and graded clinically using clinical criteria. Bispectral Index (BIS), an electroencephalographic (EEG) derived parameter is widely used in anesthesia and Critical Care setting to detect effects of anesthetic/hypnotic drugs. The aim of our study (...) of the DDS symptoms in the "non-DDS group" An assigned nephrologist will assess the physical and mental status of the patients. Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 20 participants Observational Model: Cohort Time Perspective: Prospective Official Title: The Utility of Using the Bispectral Index (BIS) for Detecting Dialysis Disequilibrium Syndrome (DDS) Actual Study Start Date : May 1, 2017 Estimated Primary Completion Date : December 1

2017 Clinical Trials

23. Dialysate Sodium Lowering Trial

Center Study Details Study Description Go to Brief Summary: This is a pilot randomized clinical trial in which patients treated with 3X per weekly conventional hemodialysis will be treated to a dialysate sodium 135 mEq/L vs. 138 mEq/L and followed for safety and tolerability, effects on BP and volume. Condition or disease Intervention/treatment Phase Hemodialysis Complication Fluid Overload Dialysis Disequilibrium Intra-dialytic Hypotension Hypertension Other: Dialysate Sodium Lowering Phase 2 (...) Participant Data (IPD) Sharing Statement: Plan to Share IPD: Undecided Layout table for additional information Studies a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Product Manufactured in and Exported from the U.S.: No Keywords provided by Tufts Medical Center: hemodialysis fluid overload dialysis disequilibrium intra-dialytic hypotension dialysate sodium lowering Additional relevant MeSH terms: Layout table for MeSH terms Hypotension Vascular Diseases

2017 Clinical Trials

24. Emergency Care in ESRD

in ESRD Aka: Emergency Care in ESRD , End-stage Renal Disease Emergency Evaluation , Dialysis Emergencies , Hemodialysis Emergency II. History: Presenting emergency complaints in ESRD Uremic ( risk) Electrolyte abnormalities (see management below) See or See ralized symptoms related to inadequate or excessive or Weakness or Lethargy Shunt related complications Shunt thrombosis (or stenosis from intimal hyperplasia) See evaluation and management below Shunt bleeding Steal Syndrome (limb ischemia during (...) ) followed by reassessment of fluid status See Consider synthetic salmon XI. Management: Hospitalization Criteria Emergency required (with pulmonary edema) (especially >7 or EKG Changes) Cardiopulmonary conditions Air embolism (suspected) during Arrhythmia ( ) Uncontrolled bleeding at access site Severe ( or ) Diastolic >130 mmHg despite aggressive management (especially ) Neurologic conditions Disequilibrium Syndrome (suspected) Gastrointestinal conditions (e.g. peptic ulcer, ) with hemodynamically

2018 FP Notebook

25. Automatic Adaptive System Dialysis (AASD)

of AASD on intradialytic hypotension but also on thirst, cramps, headache, nausea, vomiting, hypotensive events observed in basal treatment (HD or HDF). Condition or disease Intervention/treatment Phase Dialysis Intolerance Other: AASD dialysis technique Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Official Title: Automatic Adaptive System Dialysis (AASD) for Dialysis Related Hypotension and Intolerance: a Prospective Long-term (...) ) for at least 6 months aged more than 18 years on chronic thrice-weekly HD symptomatic hypotension during at least 30% of dialysis sessions on basal treatment in the last month before admission or/and 1 hypotension /week disequilibrium symptoms (cramps, headache, nausea, vomiting, hypotensive events) in at least 30% of dialysis sessions on basal treatment dialysis session time: 4 hours (as much as possible) Signed inform consent form Patients having no vascular access related problems (bi-ponction, blood

2010 Clinical Trials

26. Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies. Full Text available with Trip Pro

. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.Copyright © 2017 by the American Society of Nephrology. (...) Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies. Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence

2016 Clinical Journal of the American Society of Nephrology

27. Uremia (Treatment)

) to avoid dialysis disequilibrium syndrome, but dialysis should continue long enough to remove potassium if it is being initiated for this reason. Therapy should be initiated with the care and oversight of a nephrologist and may need to occur in the intensive care unit if the patient is unstable or has cardiac abnormalities secondary to acidemia or hyperkalemia. Outpatient care Outpatient care should be administered under the direction of the consulting nephrologist. Outpatient care may include (...) as symptoms appear, regardless of the glomerular filtration rate (GFR). Unfortunately, although dialysis effectively removes urea, it is less effective than the normal kidney at removing a number of toxic solutes, the accumulation of which is thought to lead to signs and symptoms that have been labeled residual syndrome. [ ] For patients with uremic pruritus, Shirazian et al propose a multifaceted approach that includes the following [ ] : Ensure that patients are meeting goals for dialysis efficiency

2014 eMedicine.com

28. Uremia (Follow-up)

) to avoid dialysis disequilibrium syndrome, but dialysis should continue long enough to remove potassium if it is being initiated for this reason. Therapy should be initiated with the care and oversight of a nephrologist and may need to occur in the intensive care unit if the patient is unstable or has cardiac abnormalities secondary to acidemia or hyperkalemia. Outpatient care Outpatient care should be administered under the direction of the consulting nephrologist. Outpatient care may include (...) as symptoms appear, regardless of the glomerular filtration rate (GFR). Unfortunately, although dialysis effectively removes urea, it is less effective than the normal kidney at removing a number of toxic solutes, the accumulation of which is thought to lead to signs and symptoms that have been labeled residual syndrome. [ ] For patients with uremic pruritus, Shirazian et al propose a multifaceted approach that includes the following [ ] : Ensure that patients are meeting goals for dialysis efficiency

2014 eMedicine.com

29. Emergency Care in ESRD

in ESRD Aka: Emergency Care in ESRD , End-stage Renal Disease Emergency Evaluation , Dialysis Emergencies , Hemodialysis Emergency II. History: Presenting emergency complaints in ESRD Uremic ( risk) Electrolyte abnormalities (see management below) See or See ralized symptoms related to inadequate or excessive or Weakness or Lethargy Shunt related complications Shunt thrombosis (or stenosis from intimal hyperplasia) See evaluation and management below Shunt bleeding Steal Syndrome (limb ischemia during (...) ) followed by reassessment of fluid status See Consider synthetic salmon XI. Management: Hospitalization Criteria Emergency required (with pulmonary edema) (especially >7 or EKG Changes) Cardiopulmonary conditions Air embolism (suspected) during Arrhythmia ( ) Uncontrolled bleeding at access site Severe ( or ) Diastolic >130 mmHg despite aggressive management (especially ) Neurologic conditions Disequilibrium Syndrome (suspected) Gastrointestinal conditions (e.g. peptic ulcer, ) with hemodynamically

2015 FP Notebook

30. Central nervous system pH in uremia and the effects of hemodialysis. Full Text available with Trip Pro

Central nervous system pH in uremia and the effects of hemodialysis. Rapid hemodialysis of uremic animals may induce a syndrome characterized by increased cerebrospinal fluid (CSF) pressure, grand mal seizures, and electroencephalographic abnormalities. There is a fall in pH and bicarbonate concentration in CSF, and brain osmolality exceeds that of plasma, resulting in a net movement of water into the brain. This syndrome has been called experimental dialysis disequilibrium syndrome. The fall

1976 Journal of Clinical Investigation

31. Mannitol Full Text available with Trip Pro

Mannitol Mannitol may be useful clinically both as a diuretic and as an obligate extracellular solute. As a diuretic it can be used to treat patients with intractable edema states, to increase urine flow and flush out debris from the renal tubules in patients with acute tubular necrosis, and to increase toxin excretion in patients with barbiturate, salicylate or bromide intoxication. As an obligate extracellular solute it may be useful to ameliorate symptoms of the dialysis disequilibrium (...) syndrome, to decrease cerebral edema following trauma or cerebrovascular accident, and to prevent cell swelling related to renal ischemia following cross-clamping of the aorta. Largely unexplored uses for mannitol include its use as an osmotic agent in place of dextrose in peritoneal dialysis solutions, its use to maintain urine output in patients newly begun on hemodialysis, and its use to limit infarct size following acute myocardial infarction.

1979 Western Journal of Medicine

32. Hypervolemia in ESRD Patients in Zonguldak (Prospective Study)

the potential to improve dialysis outcome in the majority of patients all over the world, The aim of the present project is to assess the feasibility of volume control by using a BİS device. Condition or disease Intervention/treatment Phase Hemodialysis Fluid Allergy Device: Dry weight adjustment Phase 4 Detailed Description: The excessive mortality of dialysis patients, particularly from cardiovascular events, is undoubtedly related for a large part to hypertension and cardiac damage(1). Most studies (...) reveal that hypertension persists despite antihypertensive drugs. Some authors (Parfrey) have used the term ''natural history'' of heart disease in dialysis, suggesting that deterioration is inevitably linked to that procedure (2). In sharp contrast, other studies (Charra, Özkahya)(3,4) have shown that a strict volume control strategy decreases blood pressure (BP) without drugs, and prolongs survival. This suggests that volume control is insufficient in most dialysis centers, despite the fact

2011 Clinical Trials

33. Effect of the MTHFR C677T and A1298C polymorphisms on survival in patients with advanced CKD and ESRD: a prospective study. (Abstract)

in Kidney and End-Stage Renal Disease [HOST]) of the effect on all-cause mortality of vitamin-induced lowering of plasma homocysteine levels. Of 677 patients, 213 (31%) were treated by using dialysis (end-stage renal disease [ESRD]) and 464 (69%) had a Cockcroft-Gault estimated creatinine clearance less than 30 mL/min (advanced CKD).Polymorphisms C677T (rs1801133) and A1298C (rs1801131) of the MTHFR gene.Unadjusted and adjusted all-cause mortality.DNA was extracted from blood samples and amplified (...) Effect of the MTHFR C677T and A1298C polymorphisms on survival in patients with advanced CKD and ESRD: a prospective study. Abnormalities in the gene regulating methylenetetrahydrofolate reductase (MTHFR) are associated with increased homocysteine levels and increased mortality in normal and chronic kidney disease (CKD) populations.Gene association study.This was a substudy of 677 patients from 21 Veterans Affairs medical centers participating in a randomized clinical trial (Homocysteinemia

2009 American journal of kidney diseases : the official journal of the National Kidney Foundation Controlled trial quality: uncertain

34. Intradialytic Drug Removal by Short-daily Hemodialysis

of vancomycin, gentamicin, and levofloxacin by short-daily HD. Determine the extent of vancomycin removal when administered during the last hour of short-daily HD. Develop drug-dosing guidelines for vancomycin, gentamicin and levofloxacin for patients receiving short-daily HD. Condition or disease Intervention/treatment Phase End Stage Renal Disease Infection Drug: Intravenous antibiotics Not Applicable Detailed Description: Despite improvements in dialysis machine and filter technology and refinements (...) in providing an adequate "dose" of HD, patients receiving thrice-weekly hemodialysis (HD) have an alarming 20% annual mortality rate. Concomitant with this high mortality rate, patients with end stage renal disease (ESRD) also endure poorer qualities of life and medical complications such as anemia, infection, accelerated cardiovascular disease and bone disease associated with calcium-phosphorus disequilibrium. Recently, quotidian dialysis regimens, which include both the short-daily and nocturnal

2008 Clinical Trials

35. Low prevalence of nonconservative mutations of serum and glucocorticoid-regulated kinase (SGK1) gene in hypertensive and renal patients. Full Text available with Trip Pro

for salt-mediated increases in BP and hypertension-related progression to end-stage renal disease (ESRD).The SGK1 gene was analysed for mutations in the exons 4, 5, 8 and 10-12, because of potential phosphorylation sites, in 591 subjects, including 311 ESRD patients (either dialysis or transplanted). In addition, an intron 6 single-nucleotide polymorphism (SNP) described previously was also investigated in this study. Genotyping was performed either by using a strategy based on single strand (...) %). There was no association between the SNP in exon 8 and either BP within the control population or progression of renal disease in the ESRD population. The second SNP at codon 398 in exon 12 was identified in one patient only. Intron 6 and exon 8 SNPs were in strong linkage disequilibrium, but did not show any association with either BP or renal diseases.Based on statistical analysis homozygosity for nonconservative mutations in the coding region of the SGK1 gene is estimated at < 1/300 000 when a white Caucasian

2004 Transplantation

36. Effect of a new model of hemodialysis potassium removal on the control of ventricular arrhythmias. (Abstract)

A, without adversely affecting pre-HD plasma K levels. These results could have a considerably clinical impact not only because of the possibility of physiologically decreasing the arrhythmogenic effect of HD, but also because this effect can be considered a "marker" of the electrophysiological derangement induced by the administration of standard HD three times a week for years ("electric disequilibrium syndrome"). (...) -dialysate K gradient (treatment A). The secondary aim was to verify whether this new model is clinically safe. In treatment B, the initial dialysate K concentration had to be 1.5 mEq/liter less than the plasma K concentration, and exponentially decrease to 2.5 mEq/liter at the end of HD. Forty-two chronic HD patients with an increase in premature ventricular complexes (PVC) during dialysis were enrolled from 18 participating centers, and randomly assigned to either sequence 1 (ABA) or sequence 2 (BAB

1996 Kidney international Controlled trial quality: uncertain

37. Hemodialysis increases apparent diffusion coefficient of brain water in nephrectomized rats measured by isotropic diffusion-weighted magnetic resonance imaging. Full Text available with Trip Pro

Hemodialysis increases apparent diffusion coefficient of brain water in nephrectomized rats measured by isotropic diffusion-weighted magnetic resonance imaging. The nature of brain edema in dialysis disequilibrium syndrome (DDS) was investigated by diffusion-weighted magnetic resonance imaging (DWI). DWI was performed on normal or bilaterally nephrectomized rats before, and immediately after, hemodialysis. Hemodialysis was performed with a custom-made dialyzer (surface area 150 cm2) against (...) ) of the brain water was not affected by bilateral nephrectomy, or by hemodialysis in normal rats. In nephrectomized rats, brain Dapp was significantly increased after dialysis with non-urea bath (1.15 +/- 0.08 vs 0.89 +/- 0.07 x 10(-9)m2/sec, P < 0.01). No significant changes of brain water Dapp could be observed after dialysis with urea bath. The increased Dapp associated with DDS indicates that brain extracellular water increases and/or intracellular water decreases after hemodialysis. Our results

1996 Journal of Clinical Investigation

38. VEGF -460 genotype plays an important role in progression to chronic kidney disease stage 5. Full Text available with Trip Pro

or < or =30% increase over 5 years, n = 39) or progressors (requiring dialysis, transplantation or whose serum creatinine increased by >30% over 5 years, n = 52). Cohort 2 comprised 107 patients with various primary renal diseases, who had reached CKD stage 5 and undergone renal transplantation at the time of study. All patients were genotyped for the VEGF polymorphisms at positions -460 (C/T) and +405 (G/C). Linkage disequilibrium (LD) was established using EHplus. SNPHAP was used to estimate haplotype (...) genetic polymorphisms of VEGF or TGF-beta1 are associated with (i) progressive decline in renal function in patients with glomerular disorders (cohort 1) and (ii) predisposition to CKD stage 5 in a separate group of renal transplant recipients with various primary diseases (cohort 2).Two patient groups were studied. Cohort 1 comprised 91 patients with biopsy-proven glomerular disease who were followed-up for 5 years before categorization as either non-progressors (with stable serum creatinine

2005 Transplantation

39. The effects of dialysis on brain water and EEG in stable chronic uremia. (Abstract)

The effects of dialysis on brain water and EEG in stable chronic uremia. Cerebral edema in uremic animals and humans, as well as an EEG deterioration in humans, has been reported after dialysis. Both are manifestations of the dialysis disequilibrium syndrome (DDS). This study was designed to analyze the changes induced by dialysis in the EEG pattern (spectral analysis), in the cerebral hydration, and ventricular size (computed tomography [CT] of the brain) in a group of 11 stable uremic (...) patients. They volunteered for a randomized crossover study of 4 months each of standard hemodialysis (HD) and hypertonic hemodiafiltration (H HDF). H HDF is a dialysis technique that is shorter and more efficient than HD. An EEG recording, a CT scan of the brain, and blood biochemistry were performed before and after a HD (four hours, blood flow rate 250 mL/min) and a H HDF run (three hours, blood flow rate 400 mL/min). Approximately 6 weeks of stabilization on each treatment were allowed before

1987 American journal of kidney diseases : the official journal of the National Kidney Foundation Controlled trial quality: uncertain

40. Comparison of sodium nitroprusside added peritoneal dialysis and standard haemodialysis. (Abstract)

removal following PD and HD was 118.8 +/- 57.3 gm and 98.5 +/- 37.0 gm respectively and also there was no significant difference in total creatinine removal. No untoward effects were observed with PD. However, following HD, 5 patients developed hypotension, supraventricular tachycardia was observed in one and disequilibrium syndrome in 8 of them. Therefore, it can be concluded that SNP added PD is comparable to 4 hours of haemodialysis both clinically as well as biochemically and in situations where (...) Comparison of sodium nitroprusside added peritoneal dialysis and standard haemodialysis. Thirty patients of acute or acute on chronic renal failure (ACRF) were randomly divided into two group of 15 cases each. Group A patients received 36 cycles of intermittent peritoneal dialysis (PD) with an exchange volume of one litre and duration of one hour per cycle. The 36 cycles of PD were divided into 12 clearance periods of 3 cycles each. Sodium Nitroprusside (SNP) was added in a dose of 4 mg/litre

1996 The Journal of the Association of Physicians of India Controlled trial quality: uncertain

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