Risk factors for DDS

Q: Describe at least five risk factors for dialysis disequilibrium syndrome (DDS)?

Answer: DDS can be fatal. Proper assessment of risk factors associated with DDS can help to mitigate its effect. Some of the risk factors are:

• First hemodialysis(HD) session
• Markedly elevated blood urea nitrogen (BUN) before dialysis session
• Old age
• Pre-existing head trauma
• History of CVA
• History of seizure 
• Concomitant encephelitis/meningitis
• Concomitant hyponatremia
• History of hepatic encephalopathy
• Concomitant hypertensive emergency
• Sepsis
• History of vasculitis
• Thrombotic thrombocytopenic purpura (TTP)

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References:

1. Arieff AI. Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention. Kidney Int 1994; 45:629.

2. Patel N, Dalal P, Panesar M. Dialysis disequilibrium syndrome: a narrative review. Semin Dial 2008; 21:493.

3. Bagshaw SM, Peets AD, Hameed M, et al. Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BMC Nephrol 2004; 5:9.