Dialysis disequilibrium syndrome: a narrative review

Semin Dial. 2008 Sep-Oct;21(5):493-8. doi: 10.1111/j.1525-139X.2008.00474.x. Epub 2008 Aug 28.


Dialysis Disequilibrium Syndrome (DDS) is characterized by neurological symptoms caused by rapid removal of urea during hemodialysis. It develops primarily from an osmotic gradient that develops between the brain and the plasma as a result of rapid hemodialysis. This results in brain edema that manifests as neurological symptoms such as headache, nausea, vomiting, muscle cramps, tremors, disturbed consciousness, and convulsions. In severe cases, patients can die from advanced cerebral edema. Recent advancements in cell biology implicate the role of urea disequilibrium (with a smaller contribution from organic osmolytes) as the pathophysiological mechanism responsible for this syndrome. In this review, we discuss the pathogenesis, clinical features and prevention of DDS.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Brain Diseases, Metabolic / diagnosis
  • Brain Diseases, Metabolic / etiology*
  • Brain Diseases, Metabolic / therapy
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis / adverse effects*
  • Seizures / etiology*
  • Syndrome