Dialysis Encephalopathy: A Complication of Chronic Renal Failure
The neurological problems that patients with chronic renal failure face are relatively new to the medical world. Although dialysis was technically feasible in the 1940’s, it has only been since 1960 that techniques and equipment have been developed to make long term dialysis available as a practical treatment for end stage renal failure. Further, it has only been since 1973 when Medicare legislation was amended to include patients with chronic renal failure; and the expansion of hospital dialysis services in addition to the emergence of private outpatient hemodialysis clinics, that hemodialysis has become available for the vast majority with end stage renal failure. By increasing services to many more patients, our experience with the problems associated with long term dialysis has grown.
All body systems, including the central and peripheral nervous system, are affected by chronic renal failure and its treatment. We have developed an understanding of the long term effects of chronic hemodialysis and the physiological effects are still being studied, but some of the long term complications of chronic renal failure are still unknown. The neurological problems encountered in patients with chronic renal failure may be acute, such as dialysis disequilibrium syndrome. Dialysis disequilibrium syndrome is caused by abrupt changes in the osmotic pressure of the cerebrospinal fluid during dialysis. Chronic complications, such as uremic peripheral neuropathy and dialysis encephalopathy, also known as dialysis dementia, are also well documented. This paper will focus on one of those neurological complications of chronic renal failure namely dialysis encephalopathy.
Dialysis encephalopathy is a syndrome specific to dialysis patients that was first described by Alfrey et. al. in the early 70’s, and since then over the years many reports from other dialysis centers around the world have described similar findings. There is a characteristic set of signs and symptoms associated with dialysis encephalopathy. There is also an equal distribution among the sexes and ages, but the geographic distribution is not even.
Dialysis encephalopathy has a distinct set of characteristics. Difficulties with communication are often the presenting symptoms, followed by cognitive and motor impairment and alterations of character. Disorders of speech such as dysarthria (difficulties with articulation), dysphasia (poor speech coordination), stammering and stuttering, are characteristically the first signs of the disorder. Concomitantly, a patient often suffers with impairment of memory and depression in addition to paranoid ideas. Myoclonic jerking and seizures are also seen. Some patients have been described with dyslexia (impaired reading, writing, and spelling, without impairment in the recognition of words), dyscalculia (inability to perform mathematical problems), dyspraxia (poor performance of...