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Dialysis Disequilibrium Prevention Strategy — ESENeph MCQ

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EasyHaemodialysisDialysis Disequilibrium Prevention StrategyESENeph

A 55-year-old man with ESKD on haemodialysis presents with a 3-day history of gradually worsening confusion and asterixis. He missed his last two dialysis sessions. Bloods: urea 55 mmol/L, creatinine 1100 umol/L, K+ 6.5 mmol/L. CT head is normal. What is the most important consideration when initiating dialysis?

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Correct answer: C — Start with short, low-efficiency session

This patient has uraemic encephalopathy from missed dialysis sessions. When restarting dialysis in severely uraemic patients, dialysis disequilibrium syndrome (DDS) must be prevented by starting with short (2 hours), low-efficiency sessions using low blood flow rates (150-200 mL/min), small dialyser surface area, and avoiding complete urea normalisation. DDS occurs when rapid urea removal from blood creates an osmotic gradient across the blood-brain barrier, causing cerebral oedema. It presents with headache, nausea, seizures, and potentially brain herniation. Gradual urea reduction over serial sessions is the safe approach.

Reference: Zepeda-Orozco & Quigley 2012 – Dialysis Disequilibrium Syndrome; UKKA 2019 – HD Guidelines