Dialysis disequilibrium syndrome: A case report

Yahya, Hanik Badriyah Hidayati, Alexander Tikara Sugondo, Vania Ayu Puspamaniar, Fajar Sena Firdausa

Research output: Contribution to journalArticlepeer-review


Dialysis disequilibrium syndrome (DDS) is a rare syndrome that can occur in patients with severe azotemia undergoing an initial hemodialysis (HD) session. DDS is associated with a more rapid decrease in urea concentration in the blood than in the brain during dialysis. Although severe DDS is less common, the milder forms of DDS may be missed by doctors. A 53-year-old male patient had the main complaint of severe dizziness in the last 10 months accompanied by a sensation of a wobbling head and tinnitus in his right ear. The patient had previously been diagnosed with polycystic kidney disease in 2018 and underwent regular hemodialysis two times a week since June 2019. In the patient’s neurological status, cerebellar examination was positive for left dysmetria, left positive past pointing, Romberg test (open eye) fell to the right, and Romberg test (closed eye) fell to the right. There was no nystagmus on the patient’s neuro-ophthalmological examination. Patients with kidney failure are at risk of developing DDS, so that appropriate precautions are needed. Due to the variability of symptoms, DDS often goes undiagnosed. Thus, it is important to be aware of the risk factors for DDS so that preventive steps can be taken appropriately. Continuous case reporting will raise awareness and the opportunity for further research to improve outcome in severe cases of DDS.

Original languageEnglish
Pages (from-to)191-195
Number of pages5
JournalAnaesthesia, Pain and Intensive Care
Issue number1
Publication statusPublished - 1 Feb 2024


  • Dialysis
  • Disequilibrium
  • Dizziness
  • Polycystic Kidney


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