According to abbreviationfinder, HD stands for Hemodialysis Dysequilibrium. Hemodialysis disequilibrium is a typical complication that some patients develop with peritoneal or hemodialysis. Some doctors also use the synonyms dysequilibrium syndrome or first dialysis syndrome to describe the disease.
What is hemodialysis disequilibrium?
The typical symptoms of hemodialysis dysequilibrium are vomiting and nausea, low blood pressure, impaired consciousness and spasms in the muscles.
The hemodialysis dysequilibrium is based on the fact that the blood loses certain substances during hemodialysis. The loss of these substances occurs relatively quickly, so that the concentration in the blood drops suddenly. Possible key substances are, for example, sodium chloride and urea. These substances are characterized, among other things, by certain effects in connection with osmosis.
In the context of kidney weakness, concentrations of osmosis-active substances change. This complication usually occurs when dialysis is performed. Urea, for example, plays an important role here. Due to the sudden decrease in substances in the blood as a result of dialysis, the gradient between the blood and the intercellular area changes. As a result, more liquid moves into the cells, so that the volume is distributed differently.
It is noteworthy that the same effect also results from the excessive consumption of alcohol. Nowadays, however, hemodialysis dysequilibrium is becoming increasingly rare. Only about every 200th patient who is dependent on dialysis suffers from hemodialysis disequilibrium. The reason for the reduced risk is primarily that dialysis machine technology has improved significantly over the past few years. Modern devices have sensitive devices that continuously monitor blood values.
The typical symptoms of hemodialysis dysequilibrium result from the processes that take place during dialysis. Certain substances in the blood rapidly lose their content. As a result, there is a dangerous concentration gradient between the blood and other tissues of the human organism. The process of osmosis plays a decisive role here.
Due to diffusion processes, it is possible for certain substances to enter the bloodstream. In this way there is a risk of washing out special substances. The concentration gradient at the blood-brain barrier caused by the hemodialysis dysequilibrium is particularly dangerous. In this context, the central nervous system plays a crucial role.
This is normally protected by the blood-brain barrier from the entry of toxic metabolic products and neurotoxic substances. The protection of the central nervous system results primarily from the fact that diffusion in this area is reduced under normal circumstances. The situation is different if the concentration gradients are changed as a result of dialysis.
Due to the rapid drop in substance concentrations caused by hemodialysis, the blood-brain barrier is not able to compensate for the enormous concentration gradient quickly enough. This increases the risk of edema forming in the brain as a result of hemodialysis disequilibrium. The reason for this lies in the storage of water in the brain, whereby the increased concentrations of certain substances are reduced by a compensatory reaction of the brain. In the worst case, the patient affected by hemodialysis disequilibrium faces a coma or death.
Symptoms, Ailments & Signs
Hemodialysis dysequilibrium manifests itself in various symptoms that differ according to the severity of the disease. The typical symptoms of hemodialysis dysequilibrium are vomiting and nausea, low blood pressure, impaired consciousness and spasms in the muscles. In particularly serious cases, the affected patients also suffer from cerebral spasms.
In addition, edema may develop in the brain, which is associated with serious complications. As part of the disorders of consciousness, the sick patients are significantly more irritable and agitated than usual. On the other hand, increased sleepiness is also possible. Blood pressure usually drops sharply.
Symptoms such as pain in the head and epileptic seizures add to the initial discomfort. The cramps in the muscles are characterized by the fact that in the majority of cases they originate in the calves.
Diagnosis & course of disease
Hemodialysis disequilibrium represents a medical emergency that requires immediate treatment of the affected individuals. First, the doctor treating you begins the diagnosis with an anamnesis. He explores the symptoms, the medical history and the living conditions of the patient suffering from hemodialysis dysequilibrium.
This is followed by various clinical examinations that provide important indications of the presence of a hemodialysis dysequilibrium. Laboratory analyzes of the blood are particularly relevant here. The symptoms described by the patient typically point to the hemodialysis disequilibrium and strengthen the suspicion of the disease. The diagnosis can be made relatively reliably with the help of blood tests.
The complications and symptoms of hemodialysis disequilibrium depend relatively heavily on the severity of the disease, which is why no general prediction of the complications makes sense. In most cases, the symptoms are ambiguous, which is why the diagnosis is delayed.
The affected person feels ill and often vomits. Nausea and disturbances of consciousness can also occur. Furthermore, it can even lead to loss of consciousness, in which the patient can also injure himself. Blood pressure drops and the patient’s exercise capacity drops significantly.
Severe and stabbing headaches can also occur, which in the worst case can lead to an epileptic seizure. Most of those affected feel tired and exhausted and often cannot compensate for this tiredness with sleep. Left untreated, hemodialysis disequilibrium usually results in death.
The treatment itself takes place by shortening the dialysis sessions, while at the same time the frequency of the applications has to be increased. This means that there are no further complications or complaints and the symptoms disappear again. Life expectancy is not limited by hemodialysis dysequilibrium when sessions are shortened.
When should you go to the doctor?
Since hemodialysis disequilibrium is a serious condition that can, in the worst case, lead to the death of the person concerned, the condition should always be examined and treated by a doctor. This can avoid further complications. A doctor should be consulted if the person concerned suffers from permanent nausea or vomiting. This can also lead to low blood pressure and a slow pulse, so that the person concerned generally feels very tired and exhausted.
Muscle cramps can also indicate hemodialysis imbalance and should be evaluated by a doctor if they occur frequently. Epileptic seizures can also occur in severe cases. Furthermore, a visit to a doctor is also necessary if the person concerned suffers from severe headaches or impaired consciousness. The first examination can be carried out by a general practitioner, with further treatment having to be carried out by various other specialists.
Treatment & Therapy
The first step in treating hemodialysis disequilibrium is to interrupt the current dialysis session. To avoid future cases of hemodialysis imbalance, it is important to shorten each dialysis session. This is especially true when the patient is still at the very beginning of their dialysis treatment. Instead, the frequency of the meetings should be increased. In this way, serious complications caused by hemodialysis disequilibrium can be largely avoided.
The prevention of hemodialysis disequilibrium starts with shortening the intervals between the individual sessions of dialysis therapy. At the same time, the duration of each session should be shortened. This makes it possible to reduce the risk of hemodialysis dysequilibrium.
In most cases, the person concerned has no direct options for aftercare in the event of hemodialysis dysequilibrium. The disease itself must first and foremost be recognized and treated very early on, so that the symptoms cannot worsen further. Early diagnosis usually always has a positive effect on the further course of the disease.
Those affected should therefore consult a doctor as soon as the first symptoms and signs of the disease appear. In most cases of hemodialysis dysequilibrium, the current dialysis must be stopped so that the symptoms can be relieved. The sessions themselves are shortened, although the frequency of the sessions has to be increased significantly. Complete healing of the hemodialysis dysequilibrium is usually not possible, so that those affected are always dependent on these measures.
In general, the help and support of parents or friends is very useful, as it can make life much easier for the person concerned. Intensive and loving conversations with the patient are also necessary, which may prevent psychological problems or even depression. Due to the hemodialysis dysequilibrium, the life expectancy of the affected person is reduced in many cases.
You can do that yourself
In the case of hemodialysis dysequilibrium, the person concerned unfortunately has no special options for self-help. In most cases, the symptoms are alleviated by stopping or shortening the respective dialysis sessions, although a complete reduction is not possible. The affected person is dependent on dialysis until he receives a donor organ and the transplantation is successful. It is also not possible to make any predictions about the course of the kidney transplant.
In many cases, the patients also suffer from psychological problems. A conversation with other affected people or with a psychologist can have a very positive effect on the course of the disease. Talking to your closest friends or relatives can also remedy mental upsets and depression. Above all, friends and family have to support and assist the patient during dialysis. During the sessions, the patient can be accompanied to make the session more comfortable. The symptoms of hemodialysis disequilibrium are alleviated when the intervals between sessions are shortened and the duration of the sessions is also shortened.