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

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2024-03-20 DOI:10.1111/hdi.13147

Sidharth Kumar Sethi, Valerie Luyckx, Timothy Bunchman, Aishwarya Nair, Shyam Bihari Bansal, Bryce Pember, Kritika Soni, Savita, Dinesh Kumar Yadav, Vivek Sharma, Khalid Alhasan, Rupesh Raina

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

通过结构化血液透析方案预防晚期尿毒症患儿透析失衡综合征：质量改进计划研究。

背景：透析失衡综合征（DDS）在晚期尿毒症或间歇期后开始透析的成人和儿童患者中非常罕见，但却令人担忧。当务之急是深入了解流行病学模式、病理生理机制和预防策略，以避免这种疾病的发生：设计：前瞻性观察质量改进计划队列研究：2017年1月至2023年10月，50名18岁以下儿童患者被诊断为慢性肾脏病V期，血尿素≥200 mg/dL，入住我们的三级医疗中心开始透析：为晚期尿毒症儿科患者的血液透析制定并遵循了标准化方案。该方案包括降低尿素还原率（目标值为 20%-30%）、缩短透析疗程和线性透析液钠谱分析等措施。此外，还预防性服用甘露醇和 25% 葡萄糖，以防止透析失衡综合征的发生：测量指标：透析失衡综合征和严重透析失衡综合征的发生率、死亡率、尿素还原比（URR）、出院时的神经功能预后以及感染和低血压等并发症的发生率。在为期1年的随访中对长期结果进行了评估，包括坚持透析、肾移植、死亡和失去随访：结果：患者发病时血清肌酐和尿素水平的中位数分别为 7.93 和 224 mg/dL。共有20%的患者在发病时出现了可归因于晚期尿毒症的神经症状。透析失衡综合征的发病率为 4%（n = 2），其中严重透析失衡综合征的发病率仅为 2%（n = 1）。总死亡率为 8%（4 例），但没有一例死亡是由透析失衡综合征引起的。第一次、第二次和第三次透析的平均尿素还原率分别为 23.45%、34.56% 和 33.50%。透析失衡综合征患者出院时神经状况正常。长期结果显示，88%的患者坚持透析，38%的患者进行了肾移植：本研究的特点是单中心设计、非随机方法和样本量有限：我们的结构化方案为透析失衡综合征的低发病率提供了标准化程序框架。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.