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Dialysis disequilibrium syndrome

Lionel U Mailloux, MD, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


The dialysis disequilibrium syndrome (DDS) is an increasingly rare syndrome characterized by neurologic symptoms of varying severity that affect dialysis patients, particularly when they are first started on hemodialysis [1,2]. It is thought to be due primarily to cerebral edema.

This topic reviews DDS. Issues related to mental status changes and other acute problems during dialysis are presented separately. (See "Acute complications during hemodialysis" and "Psychiatric illness in dialysis patients" and "Seizures in patients undergoing hemodialysis".)


The incidence of DDS is poorly defined and varies according to the patient population. Most reports state that the incidence has declined [2-4]. Severe DDS is now rare in adults because of the standard use of the preventive recommendations made below (see 'Prevention' below). Another possible reason for the decreased incidence is that patients are generally initiated on dialysis at a much lower blood urea concentration than previously [3]. However, some reports suggest that the syndrome is underreported because of the broad spectrum of manifestations [5]. Less severe symptoms (such as muscle cramps and dizziness) may reflect DDS but are often not reported.

Risk factors for DDS include the following [2-6]:

First dialysis treatment

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Literature review current through: Sep 2017. | This topic last updated: Aug 01, 2016.
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