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Abstract: PO0928

Dialysis Disequilibrium Syndrome (DDS) in Hemodialysis Patients: Systematic Review

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Raina, Rupesh, Cleveland Clinic, Akron, Ohio, United States
  • Singh, Siddhartha S., Cleveland Clinic, Akron, Ohio, United States
  • Chakraborty, Ronith, Cleveland Clinic, Akron, Ohio, United States

Dialysis disequilibrium syndrome (DDS) affects patients who have missed multiple dialysis treatments, especially new initiates of hemodialysis (HD), and presents as a rare neurological complication. The conceptual pathogenesis of DDS is likely a result of multiple physiological abnormalities which we explore in this systematic review alongside preventive measures with focus on effective management strategies.


A literature search was conducted on PubMed/Medline and Embase and included studies if the patient developed DDS irrespective of age and gender. Two independent reviewers conducted the process of article selection with a thrid reviewer present to resolve any conflicts. The data was analyzed and a summary table was extracted with the following variables: study type, population group, age, patient characteristics, blood and dialysate flow rate, and study outcome. A descriptive analysis was performed analyzing the population size and frequency of symptoms and treatments utilizing the R software.


A total of 49 studies (321 samples) were identified and analyzed. There were 72.4% of patients (based on 48 studies) who reported having DDS with most common symptoms of headache (39.4%), nausea (40.4%), vomiting (39.1%), confusion (66.7%) and seizure (78.6%). Within this sample, 12 studies switched from HD to alternative dialysis modalities including continuous venovenous hemofiltration/hemodiafiltration (CVVH/CVVHDF) or peritoneal dialysis (PD) with no further reported DDS symptoms.


We have provided a comprehensive clinical practice points for both the pediatric and adolescent and young adult population; interestingly, DDS was reported more often in the early dialysis era prior to recent advances and improvement of resource allocation. Existing literature shows it is crucial to recognize symptoms of DDS and implement timely prevention to improve outcomes.