When the kidneys fail gradually, various chemical substances that are usually eliminated by the kidneys, accumulate in the blood.   The levels of these chemicals gradually increase. In chronic renal failure this process of increasing levels of chemicals happen over a period of many years.  The body in general, and the brain in particular, make certain chemical adjustments to reach and maintain a chemical equilibrium with blood, so that they could continue to function under this altered internal chemical environment.

        When the concentration of such chemicals in the blood reach a certain critical level, the body is unable to compensate or tolerate. At this stage, the patient will require dialysis to control the Uremia.

        When the dialysis is started, esp., Hemodialysis, various chemicals are removed rapidly from the blood. Various organs, esp., Brain, do not have the ability to re-equilibrate to the new (closer to normal) internal chemical environment as rapidly as the chemicals are being removed from the blood.   This destabilizes the established equilibrium mentioned above. In turn, this destabilization causes various symptoms, as listed below.  Those symptoms are collectively called Disequilibrium Syndrome.

                                *   Nausea / vomiting
                                *   Weak and tired
                                *   Wide fluctuations of the blood pressure
                                *   Headaches, Muscle cramps
                                *   In severe cases:  tremors of the arms and legs, confusion,
                                                                disorientation and even convulsions.

Prevention:    In order the avoid this complication  at the time of initiation of dialysis treatment most of the nephrologists prefer starting dialysis treatment early in the course of uremia.  When this is not feasible then one or more of the following preventive measures will be taken at the initiation of dialysis:

            1.   Minimize the initial dose of dialysis by low blood flow and short duration of treatment
            2.   Dialyze with high sodium and low bicarbonate concentrations
            3.   Administer certain medications if necessary prior to, during  or after dialysis
                    (Medications like Dilantin, Mannitol and Valium)

112403