SynthesisPediatric nephrology (Berlin, Germany)2022
Dialysis disequilibrium syndrome (DDS) in pediatric patients on dialysis: systematic review and clinical practice recommendations.
Synthesis in Pediatric nephrology (Berlin, Germany), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Interventions for preventing haemodialysis dysequilibrium syndrome.The Cochrane database of systematic reviews · 2024Pooled it
- Intractable dialysis-associated headache: a management dilemma in pediatric hemodialysis.Pediatric nephrology (Berlin, Germany) · 2026Article
- Beyond Kidney Function: A Neuro-Renal Perspective on Personalized Care in Pediatric Chronic Kidney Disease.Medical sciences (Basel, Switzerland) · 2026Review
- Enhancing outcomes in pediatric populations with continuous renal replacement therapy: Current multidisciplinary strategies and innovations.Journal of intensive medicine · 2025Review
- Development and Investigation of a New Polysulfone Dialyzer with Increased Membrane Hydrophilicity.Membranes · 2025Review
- Assessment and management of emergencies during haemodialysis.Journal of nephrology · 2025Review
- Dialysis disequilibrium syndrome in neurosurgery: literature review and illustrative case example.GeroScience · 2024Review
- Dialysis Disequilibrium Syndrome With Cerebral Edema in an Adult Patient Following the Initial Dialysis Session.Cureus · 2024Article
- Dialysis disequilibrium syndrome in a child with uncal herniation: successful management.Journal of nephrology · 2024Article
- Hyperosmolarity in children with hyperammonemia: a risk of brain herniation at the start of renal replacement therapy.Frontiers in pediatrics · 2024Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesDialysis disequilibrium syndrome (DDS) is a rare neurological complication, most commonly affecting patients undergoing new initiation of hemodialysis (HD), but can also be seen in patients receiving chronic dialysis who miss regular treatments, patients having acute kidney injury (AKI), and in those treated with continuous kidney replacement therapy (CKRT) or peritoneal dialysis (PD). Although the pathogenesis is not well understood, DDS is likely a result of multiple physiological abnormalities. In this systematic review, we provide a synopsis of the data available on DDS that allow for a clear picture of its pathogenesis, preventive measures, and focus on effective management strategies.
methodsWe conducted a literature search on PubMed/Medline and Embase from January 1960 to January 2021. Studies were included if the patient developed DDS irrespective of age and gender. A summary table was used to summarize the data from individual studies and included study type, population group, age group, sample size, patient characteristics, blood and dialysate flow rate, and overall outcome. A descriptive analysis calculating the frequency of population size, symptoms, and various treatments was performed using R software version 3.1.0.
resultsA total of 49 studies (321 samples) were identified and analyzed. Out of the included 49 studies, a total of 48 studies reported the presence of DSS among patients (1 study reported based on number of dialysis and therefore was not considered for analysis). Among these 48 studies, 74.3% (226/304) patients were reported to have DSS. The most common symptoms were nausea (25.2%), headache (24.8%), vomiting (23.9%), muscle cramps (18.1%), affected level of consciousness (8.8%), confusion (4.4%), and seizure (4.9%) among the 226 DDS patients. Furthermore, 12 studies decided to switch from HD to alternative dialysis modalities including continuous venovenous hemofiltration/hemodiafiltration (CVVH/CVVHDF) or PD which reported no DDS symptoms.
conclusionEarly recognition and timely prevention are crucial for DDS patients. We have provided comprehensive clinical practice points for pediatric, adolescent, and young adult populations. However, it is essential to recognize that DDS was reported more frequently in the early dialysis era, as there was a lack of advanced dialysis technology and limited resources.
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