Hemodialysis dysequilibrium is a typical complication that develops in some patients in connection with peritoneal or hemodialysis. The condition is also referred to by some physicians with the synonyms dysequilibrium syndrome or first-dialysis syndrome.
What is hemodialysis dysequilibrium?
Hemodialysis dysequilibrium is based on the fact that the blood loses certain substances during hemodialysis. The loss of these substances occurs relatively rapidly, so that the concentration in the blood decreases abruptly. Possible key substances include sodium chloride and urea. These substances are characterized, among other things, by certain effects related to osmosis. In the context of kidney weakness, concentrations of osmosis-active substances change. This complication usually occurs when dialysis is performed. Urea, for example, plays an important role here. The sudden decrease in substances in the blood as a result of dialysis changes the gradient between the blood and the intercellular area. This causes more fluid to move into the cells, so that the volume is distributed differently. It is noteworthy that the same effect also results from the excessive consumption of alcohol. However, in today’s world, hemodialysis dysequilibrium is occurring less and less frequently. Only about one in 200 patients on dialysis develops hemodialysis dysequilibrium. The reason for the reduced risk is primarily that the technology of dialysis machines has improved significantly over the past few years. Modern machines have sensitive devices that continuously monitor blood levels.
Causes
The typical symptoms of hemodialysis dysequilibrium result from the processes that take place during dialysis. Certain substances in the blood rapidly lose their content. As a result, there is a dangerous concentration gradient between the blood and other tissues of the human organism. The process of osmosis plays a decisive role in this. Due to processes of diffusion, it is possible for certain substances to enter the bloodstream. In this way, there is a risk of special substances being washed out. Particularly dangerous is the concentration gradient at the blood-brain barrier caused by the hemodialysis dysequilibrium. In this context, the central nervous system plays a crucial role. This is normally protected by the blood-brain barrier from the entry of toxic metabolites as well as neurotoxic substances. The protection of the central nervous system results primarily from the fact that diffusion in this area is reduced under normal circumstances. The situation is different when concentration gradients are altered as a result of dialysis. Due to the rapid drop in substance concentrations caused by hemodialysis, the blood-brain barrier is not able to compensate quickly enough for the enormous concentration gradient. This increases the risk of edema forming in the brain due to hemodialysis dysequilibrium. This is caused by the retention of water in the brain, whereby a compensatory reaction of the brain lowers the elevated concentrations of certain substances. In the worst case, the patient affected by hemodialysis dysequilibrium is at risk of coma or death.
Symptoms, complaints, and signs
Hemodialysis dysequilibrium manifests itself in various signs of illness, which vary according to the severity of the disease. The typical symptoms of hemodialysis dysequilibrium are vomiting and nausea, low blood pressure, impaired consciousness, and muscle spasms. In particularly severe cases, affected patients also suffer from cerebral spasms. In addition, edema may develop in the brain, which is associated with serious complications. In the context of the disturbances of consciousness, the ill patients are clearly more irritable and agitated than usual. On the other hand, increased sleepiness is also possible. Blood pressure usually drops sharply. Symptoms such as pain in the area of the head and epileptic seizures join the initial complaints. The cramps in the muscles are characterized by the fact that in the majority of cases they start from the calves.
Diagnosis and course of the disease
Hemodialysis dysequilibrium is a medical emergency that requires immediate treatment of affected individuals. First, the attending physician begins the diagnostic process by taking a medical history. In this process, he or she investigates the symptoms, the medical history and the circumstances of the patient suffering from hemodialysis dysequilibrium. This is followed by various clinical examinations that provide important indications of the presence of hemodialysis dysequilibrium. Laboratory analyses of the blood are particularly relevant. The symptoms described by the patient typically indicate hemodialysis dysequilibrium and strengthen the suspicion of the disease. The diagnosis can be made with relative certainty with blood tests.
Complications
Complications and discomfort from hemodialysis dysequilibrium are relatively dependent on the severity of the disease, which is why no general prediction of complications is useful. In most cases, the symptoms are ambiguous, which is why the diagnosis is delayed. The affected person feels ill and often has to vomit. Nausea and disturbances of consciousness may also occur. Furthermore, there may even be a loss of consciousness, during which the patient may also injure himself. Blood pressure drops and the patient’s ability to cope with stress decreases considerably. Severe and stabbing headaches can also occur, which in the worst case can lead to an epileptic seizure. Most sufferers feel tired and weary and are often unable to compensate for this fatigue by sleeping. Without treatment, hemodialysis dysequilibrium usually causes the patient to die. The treatment itself involves shortening dialysis sessions while increasing the frequency of applications. Thus, there are no further complications or discomfort and the symptoms disappear again. Life expectancy is not reduced by hemodialysis dysequilibrium if the sessions are shortened.
When should you see a doctor?
Because hemodialysis dysequilibrium is a serious condition that, in the worst case, can lead to the death of the affected person, the condition should always be examined and treated by a physician. This can prevent further complications. A doctor should be consulted if the affected person suffers from persistent nausea or vomiting. This can also lead to low blood pressure and a slow pulse, so that the affected person generally feels very tired and listless. Furthermore, cramps in the muscles may also be indicative of hemodialysis dysequilibrium and should be examined by a physician if they occur frequently. Likewise, epileptic seizures may also occur in severe cases. Furthermore, a visit to a physician is also necessary if the affected person suffers from severe headaches or impaired consciousness. In this case, the initial examination may be performed by a general practitioner, although further treatment must be provided by various other specialists.
Treatment and therapy
Treatment of hemodialysis dysequilibrium starts by stopping the current dialysis session. To prevent future cases of hemodialysis dysequilibrium, it is important to shorten each dialysis session. This is especially true when the patient is at the very beginning of their dialysis treatment. Instead, the frequency of sessions should be increased. In this way, serious complications due to hemodialysis disequilibrium can be largely avoided.
Prevention
Prevention of hemodialysis dysequilibrium starts from shortening the interval between each session of dialysis therapy. At the same time, the duration of each session should be shortened. Thus, it is possible to reduce the risk of hemodialysis dysequilibrium.
Follow-up
In most cases, the person affected by hemodialysis dysequilibrium has no direct options for aftercare. In the first instance, the disease itself must be detected and treated at a very early stage to prevent further worsening of symptoms. As a rule, early diagnosis always has a positive effect on the further course of the disease. Those affected should therefore see a doctor at the first symptoms and signs of the disease.In most cases, hemodialysis dysequilibrium requires discontinuation of the current dialysis session in order to relieve symptoms. The sessions themselves are shortened in the process, and the frequency of sessions must be significantly increased. A complete cure for hemodialysis dysequilibrium is usually not possible, so sufferers will always need to rely on these measures. In general, the help and support of parents or of friends is very useful, as this can greatly facilitate the life of the affected person. Likewise, intensive and loving conversations with the patient are necessary, which can possibly prevent psychological complaints or even depression. Because of hemodialysis dysequilibrium, in many cases the life expectancy of the affected person is reduced.
What you can do yourself
In hemodialysis dysequilibrium, unfortunately, there are usually no particular self-help options available to the affected person. In most cases, the discomfort is alleviated by discontinuing or shortening the respective dialysis sessions, although complete restriction is not possible. The patient is dependent on dialysis until he or she receives a donor organ and the transplantation is successful. No prediction can be made about the course of the kidney transplant either. In many cases, patients also suffer from psychological complaints. In this case, a conversation with other affected people or with a psychologist can have a very positive effect on the course of the disease. Talks with the closest friends or with relatives can also resolve psychological upsets and depression. Above all, friends and family need to support and assist the patient during dialysis. During the sessions, the patient can be accompanied to make the session more comfortable. The discomfort of hemodialysis dysequilibrium is then relieved when the intervals between sessions are shortened and the duration of the sessions is shortened as well.