ArticleNeurocritical care2015
Rapid unexpected brain herniation in association with renal replacement therapy in acute brain injury: caution in the neurocritical care unit.
Article in Neurocritical care, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 45 citations in OpenAlex.
- A Single-Center Review of Renal Replacement Therapy in Patients With Acute Traumatic Brain Injury.Cureus · 2025Article
- Hyperosmolarity in children with hyperammonemia: a risk of brain herniation at the start of renal replacement therapy.Frontiers in pediatrics · 2024Article
- Kidney Dysfunction After Traumatic Brain Injury: Pathophysiology and General Management.Neurocritical care · 2023Review
- Acute Kidney Injury at the Neurocritical Care Unit.Neurocritical care · 2022Review
- Recovery of severe dialysis disequilibrium syndrome with uncal herniation following therapy with mannitol, hyperventilation and hypertonic saline.Clinical kidney journal · 2022Article
- Dialysis disequilibrium on CKRT: avoiding the steep slippery slope.Pediatric nephrology (Berlin, Germany) · 2021Article
- Dialysis Disequilibrium Syndrome in a Patient With Acute Kidney Injury on Chronic Kidney Disease.Cureus · 2021Article
- Dialysis Disequilibrium Syndrome and Cerebellar Herniation with Successful Reversal Using Mannitol.Case reports in nephrology · 2020Article
- Reply to ChoustermanAmerican journal of respiratory and critical care medicine · 2019Article
- Therapeutic hypernatremia management during continuous renal replacement therapy with elevated intracranial pressures and respiratory failure.Reviews in endocrine & metabolic disorders · 2019Review
- Article
- Osmotic Shifts, Cerebral Edema, and Neurologic Deterioration in Severe Hepatic Encephalopathy.Critical care medicine · 2018Article
- Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury.Case reports in critical care · 2017Article
- Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine.Neurocritical care · 2016Review
- Haemodialysis is an effective treatment in acute metabolic decompensation of maple syrup urine disease.Molecular genetics and metabolism reports · 2015Article
- A brain-kidney connection: the delicate interplay of brain and kidney physiology.Neurocritical care · 2015Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionWe aim to raise awareness for the potential for rapid brain edema and herniation in acutely brain-injured patients undergoing renal replacement therapy (RRT), including one case undergoing continuous veno-venous hemofiltration. Dialysis disequilibrium syndrome (DDS) may have been a possible cause for the brain edema.
methodsWe retrospectively reviewed four consecutive neurocritically ill patients in acute renal failure undergoing RRT between 2011 and 2013. Imaging, blood pressure, and laboratory data pre-, during, and post-RRT are presented in graphical form. We performed an extensive literature review.
resultsAll patients suffered rapidly progressive herniation and death from global brain edema closely related in time to RRT, without other identifiable causes even after detailed review by three neurointensivists. Common clinical symptoms included sudden onset fixed and dilated pupils with apnea, consistent with brain stem compression. Herniation was not reversed by high-dose osmotherapy, and all patients died. Our detailed literature review provides plausible mechanisms for DDS as the most likely cause for our patients' brain edema.
conclusionsEven today, sudden brain edema and herniation may occur in association with RRT in neurocritically ill patients. We call for the establishment of RRT guidelines in patients with acute neurological injuries.
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