{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T14:28:36Z","timestamp":1769264916593,"version":"3.49.0"},"reference-count":8,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Dialysis disequilibrium syndrome (DDS) is a rare but serious neurologic complication of hemodialysis caused by rapid osmotic shifts leading to cerebral edema. Although well recognized in nephrology, DDS is underappreciated in neurosurgical practice, where it often presents only after significant intracranial hypertension has developed. As dialysis use expands, early neurosurgical awareness is increasingly important.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This narrative review synthesizes current evidence on DDS pathophysiology, clinical features, diagnostic considerations, and management, with a specific focus on neurosurgical implications. Data from case reports, pooled analyses, and neurocritical care studies were examined to characterize intracranial pressure (ICP) changes associated with renal replacement therapy and to identify points for multidisciplinary intervention.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n DDS most frequently occurs during early or rapid hemodialysis in patients with markedly elevated urea levels. A pooled analysis shows ICP elevation in up to 73% of neurosurgical patients receiving intermittent hemodialysis versus 38% treated with continuous modalities. Despite these risks, standardized neurosurgical protocols for prevention or monitoring remain lacking. Evidence supports gradual urea clearance, early use of continuous therapies, and timely hyperosmolar treatment when cerebral edema develops. However, delayed recognition and limited cross-disciplinary coordination continue to hinder effective management.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n DDS is a preventable neurocritical complication that requires stronger integration into neurosurgical practice. Improved interdisciplinary communication, structured monitoring strategies, and incorporation of DDS into neurocritical care training could support earlier recognition and safer dialysis initiation. Reframing DDS as a shared neurosurgical\u2013nephrology responsibility is essential to moving from reactive treatment toward prevention and improving neurologic outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_1287_2025","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:58:09Z","timestamp":1769151489000},"page":"40","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dialysis disequilibrium syndrome: An overview of the current neurosurgical state"],"prefix":"10.25259","volume":"17","author":[{"given":"Jacob","family":"Gould","sequence":"first","affiliation":[{"name":"Department of Post-baccalaureate Studies, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saarang","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Seton Hall University, South Orange, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bipin","family":"Chaurasia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"10.25259\/SNI_1287_2025\/ref-1","first-page":"e5000","article-title":"Dialysis disequilibrium syndrome: Rare serious complication of hemodialysis and effective management","volume":"11","author":"Adapa","year":"2019","journal-title":"Cureus"},{"key":"10.25259\/SNI_1287_2025\/ref-2","article-title":"Dialysis disequilibrium syndrome","volume-title":"StatPearls","author":"Bhandari","year":"2025"},{"key":"10.25259\/SNI_1287_2025\/ref-3","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1053\/ajkd.2001.22068","article-title":"Renal replacement therapy in the patient with acute brain injury","volume":"37","author":"Davenport","year":"2001","journal-title":"Am J Kidney Dis"},{"key":"10.25259\/SNI_1287_2025\/ref-4","doi-asserted-by":"crossref","first-page":"5431","DOI":"10.1007\/s11357-024-01109-z","article-title":"Dialysis disequilibrium syndrome in neurosurgery: Literature review and illustrative case example","volume":"46","author":"Evans","year":"2024","journal-title":"GeroScience"},{"key":"10.25259\/SNI_1287_2025\/ref-5","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/ckj\/sfab165","article-title":"Recovery of severe dialysis disequilibrium syndrome with uncal herniation following therapy with mannitol, hyperventilation and hypertonic saline","volume":"15","author":"Liu","year":"2021","journal-title":"Clin Kidney J"},{"key":"10.25259\/SNI_1287_2025\/ref-6","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2147\/IJNRD.S165925","article-title":"Dialysis disequilibrium syndrome prevention and management","volume":"12","author":"Mistry","year":"2019","journal-title":"Int J Nephrol Renovasc Dis"},{"key":"10.25259\/SNI_1287_2025\/ref-7","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.wneu.2022.11.142","article-title":"Dialysis disequilibrium syndrome and intracranial pressure fluctuations in neurosurgical patients undergoing renal replacement therapy: Systematic review and pooled analysis","volume":"170","author":"Parsons","year":"2023","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_1287_2025\/ref-8","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/j.1525-139X.2008.00474.x","article-title":"Dialysis disequilibrium syndrome: A narrative review","volume":"21","author":"Patel","year":"2008","journal-title":"Semin Dial"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/dialysis-disequilibrium-syndrome-an-overview-of-the-current-neurosurgical-state\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/dialysis-disequilibrium-syndrome-an-overview-of-the-current-neurosurgical-state\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:58:14Z","timestamp":1769151494000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/dialysis-disequilibrium-syndrome-an-overview-of-the-current-neurosurgical-state\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":8,"alternative-id":["10.25259\/SNI_1287_2025"],"URL":"https:\/\/doi.org\/10.25259\/sni_1287_2025","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"article-number":"40"}}