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Kidney Week

Abstract: SA-PO735

Risk of the Dialysis Disequilibrium Syndrome in Japanese Elderly

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Kagaya-Takeuchi, Saeko, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
  • Sato, Hiroyuki, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
  • Yamada, Gen, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
  • Takeuchi, Yoichi, Tohoku University Hospital, Sendai, Japan
  • Nagasawa, Tasuku, Tohoku University Hospital, Sendai, Japan
  • Miyazaki, Mariko, Tohoku University Hospital, Sendai, Japan

In Japan, there is an increased number of elderly patients with end-stage renal disease (ESRD). Elderly patients are more likely to develop a dialysis disequilibrium syndrome (DDS). To improve their quality of life, recognizing the mild symptoms of DDS is necessary. High level of blood urea nitrogen and severe metabolic acidosis are regarded as risk factors of DDS, but the accurate incidence of them remains unclear in Japan. Here, we aim to evaluate the incidence and risk of mild to severe DDS for the well-managed ESRD patients in a single facility.


A total of 75 ESRD patients aged over 65 years were included, who had undergone scheduled hemodialysis after arteriovenous fistula creation at our hospital from 2015 through 2017. The DDS, or primary outcome, is defined as the mild to severe symptoms developing at the first dialysis treatment like headache, nausea and/or vomiting, appetite loss, muscle cramp, psychomotor agitation, and convulsions. Demographics and clinical data obtained before first dialysis were assessed as covariates to calculate the adjusted odds ratio in the multivariate analysis.


The DDS was observed in 23 of 75 patients of interest. Headache was the most common symptom of them. Logistic regression model revealed that low level of eGFR, excessive fluid removal, and non-medication of sodium bicarbonate were independently associated with DDS in the ESRD elderly. Oral sodium bicarbonate was administered to 36 patients. Significant difference was found in serum [HCO3-] between two groups with and without oral sodium bicarbonate (median 19.7 mEq/L [IQR: 13.1 - 29.1] vs. median 17.0 mEq/L [IQR: 6.70 - 27.7], P = 0.015) using Mann-Whitney U test. These suggested that efficient dose of bicarbonate were taken in the ESRD patients. After adjustment for covariates, oral sodium bicarbonate for preventing metabolic acidosis significantly reduced the incidence of primary outcome (adjusted odds ratio 0.21 [95%CI: 0.06 - 0.77], P = 0.019).


At the first dialysis treatment for the ESRD elderly, we should pay attention to metabolic acidosis as a risk developing DDS. The effectiveness of oral sodium bicarbonate is necessary to be examined by prospective studies.