ESPN 50th Annual Meeting

ESPN 2017


 
THE TORTOISE AND THE HARE- A CASE STUDY OF HOW NXSTAGETM REDUCES THE RISK OF DIALSYS DISEQUILIBRIUM SYNDROME IN A HIGH RISK PAEDIATRIC PATIENT
ROWENA LALJI 1 KATE SINNOTT 1 DALJIT HOTHI 1

1- GREAT ORMOND STREET HOSPITAL FOR CHILDREN
 
Introduction:

Dialysis disequilibrium syndrome is a potentially life threatening complication usually associated with the commencement of haemodialysis (HD). However, paediatric patients and those with pre-existing CNS lesions remain at risk. We report the case of a dialysis dependent ten year old girl with a background of Spina Bifida and VP shunt who experienced headaches and generalized tonic-clonic seizures when dialysing using a conventional GambroTM AK200 dialysis machine.

Material and methods:

The patient generally experienced symptoms after >3 hours of dialysis. Seizures required rescue therapy and as a result, she was commenced on regular anticonvulsant medication before each HD session. Prior to starting dialysis, there was no history of headaches or seizures. We propose that this patient’s symptoms were a result of disequilibrium syndrome. Various alterations to the patient’s HD regimen to reduce the risk of disequilibrium were employed including shorter, more frequent dialysis sessions, cooling on the machine, a reduction in blood flow rate (and thus reduced rate of clearance of uraemic toxins including urea) as well as using smaller dialysers. Eventually the patient’s self-reported and witnessed symptoms were successfully minimised by moving to the NxstageTM system with equitable clearance. The patient continued on NxstageTM HD for seven months until she was successfully transplanted. Managing intra-dialytic and post dialysis symptoms was vital in our patient for whom peritoneal dialysis would have likely failed for a multitude of reasons.

Results:

We speculate that a combination of cooling and a slower rate of purification with the NxStage dialysis system was responsible for the improved tolerance to dialysis treatments compared with the GambroTM dialysis system. Thus remained true when the dialyser size was increased to improve the total treatment single pool Kt/V.

Conclusions:

HD using the NxstageTM dialysis system appears to improve the tolerance to dialysis treatments in patients prone to intradialytic symptoms and dialysis disequilibrium syndrome.