Exploring Prevalence and Predictors of Clinically Suspected Dialysis Disequilibrium Syndrome in End-Stage Kidney Disease Patients Initiating Hemodialysis

Objective: This study aimed to examine the prevalence and predictors of clinically suspected dialysis disequilibrium syndrome (DDS) in end-stage kidney disease (ESKD) patients starting their first hemodialysis session.Material and Methods: Data was retrospectively collected from a university hospital; from december 2020 to july 2023. It included adult patients receiving their first session of hemodialysis. Patient demographics, comorbidities, medications, and laboratory results were analyzed. The primary objective was to identify clinically suspected DDS using predefined criteria. Multivariate logistic regression was used to identify independent risk factors for clinically suspected DDS.Results: A total of 106 patients were enrolled. Among these, 18.8% had clinically suspected DDS, with nausea being the most prevalent symptom. The onset of symptoms varied, with a median of 240 minutes. Multivariate analysis revealed higher pre-hemodialysis serum creatinine as a risk factor for DDS (adjusted OR: 1.13; 95% CI: 1.02–1.25), while lower pre-hemodialysis serum sodium (adjusted OR: 0.90; 95% CI: 0.84–0.98) and capillary blood glucose levels (adjusted OR: 0.99; 95% CI: 0.97–1.0) were associated with increased risk. Notably, elevated blood glucose levels were protective against DDS.Conclusion: Higher pre-dialysis serum creatinine, coupled with lower sodium and glucose levels significantly predicts DDS. These findings emphasize the necessity of tailored hemodialysis prescriptions and vigilant monitoring of patients likely to develop DDS.