Which patient situation would increase the risk for developing dialysis disequilibrium syndrome?

Question

1. Peritoneal dialysis provided in a home environment
2. Patient who received an ACE inhibitor prior to hemodialysis
3. A known history of long-term substance abuse
4. Patient undergoing first hemodialysis treatment

Answer 1

4
Rationale 1: Peritoneal dialysis is a much slower process than HD because the solute and fluid removal is slower. This allows for equilibrium of cells, especially those in the brain, to adjust to the change in fluid and solutes.
Rationale 2: The use of an ACE inhibitor before HD is not contraindicated and does not contribute to disequilibrium syndrome.
Rationale 3: A history of substance abuse does not contribute to the development of disequilibrium syndrome because this disorder does not affect osmotic or pressure gradients.
Rationale 4: Dialysis disequilibrium syndrome is especially common in patients undergoing their first or second dialysis treatment who experience sudden, large decreases in their BUN. The most likely explanation for this syndrome is that the levels of urea do not drop as rapidly in the brain as the plasma because of the blood-brain barrier. The higher levels of urea in the brain result in an osmotic concentration gradient between the brain cells and the plasma. Fluid enters the brain cells by osmosis until the concentration levels equal that of the extracellular fluid, resulting in cerebral edema and the dialysis disequilibrium syndrome.