WE in dialysis

Q: What's the reason behind the increased risk of Wernicke Encephalopathy (WE) in renal dialysis patients?

Answer: Loss of the water-soluble vitamins, including thiamine 

It is a misconception that WE occurs only in heavy alcohol abuse. WE can occur in a wide range of causes, including poor nutrition, malabsorption, increased metabolic requirements, systemic illnesses, and/or increased loss of water-soluble vitamins.

Thiamine is a water-soluble vitamin that may be lost either in hemodialysis or peritoneal dialysis.

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References:

1. Hung SC, Hung SH, Tarng DC, et al. Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis 2001; 38:941.

2. Jagadha V, Deck JH, Halliday WC, Smyth HS. Wernicke's encephalopathy in patients on peritoneal dialysis or hemodialysis. Ann Neurol 1987; 21:78.

3. Descombes E, Dessibourg CA, Fellay G. Acute encephalopathy due to thiamine deficiency (Wernicke's encephalopathy) in a chronic hemodialyzed patient: a case report. Clin Nephrol 1991; 35:171.

4. Oudman E, Wijnia JW, Severs D, Oey MJ, van Dam M, van Dorp M, Postma A. Wernicke's Encephalopathy in Acute and Chronic Kidney Disease: A Systematic Review. J Ren Nutr. 2024 Mar;34(2):105-114. doi: 10.1053/j.jrn.2023.10.003. Epub 2023 Oct 13. PMID: 37838073.