Uremic and dialysis encephalopathies

Abstract

Because of advancements in dialysis therapy and renal transplantation, and their medical management, patients with end-stage renal disease (ESRD) rarely develop severe clinical manifestations before the institution of therapy. In the USA, there are currently about 450,000 patients receiving dialysis therapy (Meyer & Hostetter, 2007). Although uncommon in the USA and Canada, patients who have chronic renal failure (GFR below 30 ml/min) and have not yet received dialysis therapy may develop a symptom complex characterized by fatigue, mild sensorial clouding, decreased mental acuity, tremor, anorexia, nausea and sleep disturbances (Gusbeth-Tatomir et al., 2007; Perl et al., 2006;). However, the institution of apparently adequate maintenance dialysis therapy does not eliminate central nervous system (CNS) manifestations of uremia. CSN disorders of both untreated renal failure and those persisting despite dialysis are referred to as uremic encephalopathy. The treatment of end stage renal disease with dialysis has itself been associated with the emergence of several distinct disorders of the central nervous system. These disorders are: dialysis disequilibrium syndrome, dialysis dementia, stroke, sexual dysfunction and a new syndrome of chronic dialysis-dependent encephalopathy (Arieff, 2004).