Seizures in patients undergoing hemodialysis
- Yousri M Barri, MD
Yousri M Barri, MD
- Dallas Nephrology Associates
- Baylor University Medical Center
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
Seizures are not uncommon in patients undergoing hemodialysis . Since they are more frequent in those who require acute dialysis for a severe uremic state, the current trend toward earlier initiation of dialysis has resulted in a lower incidence of seizures among these patients.
Seizure activity generally tends to occur during or shortly after the dialysis procedure because of the hemodynamic and biochemical changes associated with the process . Preventive measures should therefore be initiated in patients with predisposing factors, such as extreme uremia or severe electrolyte abnormalities .
This topic will review the causes and treatment of seizures in dialysis patients. The management of seizures in patients without renal failure and a review of the acute complications that may occur during dialysis are presented separately. (See "Overview of the management of epilepsy in adults" and "Acute complications during hemodialysis".)
Many of the causes of seizures are similar in those with and without renal failure. However, some are specifically related to patients with uremia:
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- Uremic encephalopathy
- Dialysis disequilibrium syndrome
- Drugs or toxins
- Hemodynamic instability
- Cerebrovascular disease
- - Hypertensive encephalopathy
- - Transient ischemic attacks
- - Cerebral infarction and hemorrhage
- - Subdural hematoma
- Dialysis dementia
- Uremic encephalopathy
- Dialysis disequilibrium syndrome
- Dialyzable antiepileptic drugs
- Erythropoietin therapy
- Dialysis-induced hypotension
- MANAGEMENT OF SEIZURES
- Metabolism of antiepileptic drugs in renal failure
- Maintenance therapy
- - Phenytoin
- SUMMARY AND RECOMMENDATIONS