Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study.

Autor: Sethi SK; Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India., Luyckx V; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Bunchman T; Pediatric Nephrology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA., Nair A; Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India., Bansal SB; Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India., Pember B; Northeast Ohio Medical University, Rootstown, Ohio, USA., Soni K; Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India., Savita; Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India., Yadav DK; Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India., Sharma V; Department of Radiology, Medanta, The Medicity, Gurgaon, Haryana, India., Alhasan K; Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Raina R; Pediatric Nephrology, Akron Children's Hospital, Cleveland, Ohio, USA.
Jazyk: angličtina
Zdroj: Hemodialysis international. International Symposium on Home Hemodialysis [Hemodial Int] 2024 Apr; Vol. 28 (2), pp. 216-224. Date of Electronic Publication: 2024 Mar 20.
DOI: 10.1111/hdi.13147
Abstrakt: Background: Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment.
Design: Prospective observational quality improvement initiative cohort study.
Setting and Participants: A prospective single-center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023.
Quality Improvement Plan: A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%-30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome.
Measures: Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long-term outcomes were assessed at the 1-year follow-up including adherence to dialysis, renal transplantation, death, and loss to follow-up.
Results: The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long-term outcomes showed 88% adherence to dialysis and 38% renal transplantation.
Limitations: This study is characterized by a single-center design, nonrandomized approach, and limited sample size.
Conclusions: Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome.
(© 2024 International Society for Hemodialysis.)
Databáze: MEDLINE
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