A Critical Review of Posterior Reversible Encephalopathy Syndrome Cases in a Peritoneal Dialysis Population: Case Series and Review of Literature

Abstract

Introduction: Posterior reversible encephalopathy syndrome (PRES) represents a neurological disorder with varied clinical presentation and typical imaging findings. End-stage-renal-disease patients have a combination of riskfactors for PRES: hypertension, volume-overload, erythropoietin stimulating agents, immunosuppressants, hyponatremia, uremia. Methods: We explored the presentation and outcome of PRES in a chronic peritoneal-dialysis (PD) population over a 2-year period. We also reviewed the literature on PRES in PD. Result: 3 patients had PRES over a 2-year period. They were young, had uncontrolled hypertension and most presented shortly after PD-induction. Fluid/salt non-compliance, faster decline of urine-output after graft-failure, maintenance immunosuppression/ESA was possible triggers. Conclusion: PRES is a serious complication associated with a higher risk for dialytic modality transition since subclinical hypervolemia is a prevalent and probable risk factor. The complication is hardly predictable, with inconsistent correlation of clinical presentation, blood-pressure and weight-gain profiles after PD-induction.