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Neurological Sciences

, Volume 39, Issue 7, pp 1151–1159 | Cite as

Advances in dialysis encephalopathy research: a review

  • Ying Chen
  • Xin Tian
  • Xuefeng Wang
Review Article

Abstract

Dialysis encephalopathy (DE) is a progressive, fatal disease with a high mortality rate. Understanding the causes of this disease and the efforts to prevent and treat it would help improve the prognosis and quality of life of affected patients. This paper reviews the etiology, clinical features, methods of examining accessory features, diagnosis, treatment, and prevention of DE. We found that DE is likely to be related to aluminum poisoning. The clinical manifestations of DE include language disorders, mental and behavioral disorders, cognitive decline, and movement disorders. Electroencephalogram (EEG) findings mainly consist of an abundance of low waves, intermittent bilateral synchronous high-amplitude spikes, and ridge waves. Assessing the clinical features and obtaining an EEG are of great value in diagnosis, and DE is treated by both reducing aluminum intake and increasing aluminum excretion. Deferoxamine (DFO) is an effective treatment for DE.

Keywords

Dialysis encephalopathy Etiology Clinical features Examination Diagnosis Treatment 

Notes

Authors’ contributions

YC and XT conceived the article and wrote the manuscript. XT and XFW reviewed and edited the manuscript. YC and XT contributed equally and share first authorship. All authors read and approved the manuscript.

Funding

This study was supported by grants from the National Natural Science Foundation of China (Nos. 81471319, 81671301).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict interest.

References

  1. 1.
    Alfrey AC, Mishell JM, Burks J, Contiguglia SR, Rudolph H, Lewin E, Holmes JH (1972) Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Intern Organs 18:257–261–266–267CrossRefGoogle Scholar
  2. 2.
    Mahurkar SD, Salta R, Smith EC, Dhar SK, Meyers L Jr, Dunea G (1973) Dialysis dementia. Lancet 1(7817):1412–1415CrossRefPubMedGoogle Scholar
  3. 3.
    Alfrey AC, LeGendre GR, Kaehny WD (1976) The dialysis encephalopathy syndrome. Possible aluminum intoxication. N Engl J Med 294(4):184–188.  https://doi.org/10.1056/NEJM197601222940402 CrossRefPubMedGoogle Scholar
  4. 4.
    Chui HC, Damasio AR (1980) Progressive dialysis encephalopathy (“dialysis dementia”). J Neurol 222(3):145–157CrossRefPubMedGoogle Scholar
  5. 5.
    McKee DC, Burnett GB, Raft DD, Batten PG, Bain KP (1982) Longitudinal study of neuropsychological functioning in patients on chronic hemodialysis: a preliminary report. J Psychosom Res 26(5):511–518CrossRefPubMedGoogle Scholar
  6. 6.
    Mahurkar SD, Smith EC, Mamdani BH, Dunea G (1978) Dialysis dementia—the Chicago experience. J Dial 2(5–6):447–458CrossRefPubMedGoogle Scholar
  7. 7.
    Rozas VV, Port FK, Easterling RE (1978) An outbreak of dialysis dementia due to aluminum in the dialysate. J Dial 2(5–6):459–470CrossRefPubMedGoogle Scholar
  8. 8.
    Jack R, Rabin PL, McKinney TD (1983) Dialysis encephalopathy: a review. Int J Psychiatry Med 13(4):309–326CrossRefPubMedGoogle Scholar
  9. 9.
    Matsubara O, Nakagawa S, Shinoda T, Iwamoto H, Kanno J, Okeda R, Kasuga T (1984) Progressive multifocal leukoencephalopathy associated with prolonged hemodialysis treatment. Virchows Arch A Pathol Anat Histopathol 403(3):301–305CrossRefPubMedGoogle Scholar
  10. 10.
    Lederman RJ, Henry CE (1978) Progressive dialysis encephalopathy. Ann Neurol 4(3):199–204.  https://doi.org/10.1002/ana.410040302 CrossRefPubMedGoogle Scholar
  11. 11.
    Rizzo MA, Frediani F, Granata A, Ravasi B, Cusi D, Gallieni M (2012) Neurological complications of hemodialysis: state of the art. J Nephrol 25(2):170–182.  https://doi.org/10.5301/jn.5000087 CrossRefPubMedGoogle Scholar
  12. 12.
    Chokroverty S, Bruetman ME, Berger V, Reyes MG (1976) Progressive dialytic encephalopathy. J Neurol Neurosurg Psychiatry 39(5):411–419CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Burks JS, Alfrey AC, Huddlestone J, Norenberg MD, Lewin E (1976) A fatal encephalopathy in chronic haemodialysis patients. Lancet 1(7963):764–768CrossRefPubMedGoogle Scholar
  14. 14.
    Marshall JR (1979) Neuropsychiatric aspects of renal failure. J Clin Psychiatry 40(2):81–85PubMedGoogle Scholar
  15. 15.
    Weddington WW Jr (1978) Dementia dialytica. Psychosomatics 19(6):367–370.  https://doi.org/10.1016/S0033-3182(78)70967-9 CrossRefPubMedGoogle Scholar
  16. 16.
    Barratt LJ, Lawrence JR (1975) Dialysis-associated dementia. Aust NZ J Med 5(1):62–65CrossRefGoogle Scholar
  17. 17.
    Adams V (1977) Principles of neurology. Mc Graw-Hill, New YorkGoogle Scholar
  18. 18.
    Prior JC, Cameron EC, Knickerbocker WJ, Sweeney VP, Suchowersky O (1982) Dialysis encephalopathy and osteomalacic bone disease: a case-controlled study. Am J Med 72(1):33–42CrossRefPubMedGoogle Scholar
  19. 19.
    Nadel AM, Wilson WP (1976) Dialysis encephalopathy: a possible seizure disorder. Neurology 26(12):1130–1134CrossRefPubMedGoogle Scholar
  20. 20.
    Scheiber SC, Ziesat H Jr (1976) Dementia dialytica: a new psychotic organic brain syndrome. Compr Psychiatry 17(6):781–785CrossRefPubMedGoogle Scholar
  21. 21.
    Parkinson IS, Ward MK, Kerr DN (1981) Dialysis encephalopathy, bone disease and anaemia: the aluminum intoxication syndrome during regular haemodialysis. J Clin Pathol 34(11):1285–1294CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Haenel T, Brunner F, Battegay R (1980) Renal dialysis and suicide: occurrence in Switzerland and in Europe. Compr Psychiatry 21(2):140–145CrossRefPubMedGoogle Scholar
  23. 23.
    Ladurner G, Wawschinek O, Pogglitsch H, Petek W, Urlesberger H, Holzer H (1982) Neurophysiological findings and serum aluminium in dialysis encephalopathy. Eur Neurol 21(5):335–339.  https://doi.org/10.1159/000115500 CrossRefPubMedGoogle Scholar
  24. 24.
    Luda E (1984) The EEG in progressive dialysis encephalopathy: the EEG in diagnosing and screening for PDE. (Part. I). Ital J Neurol Sci 5(4):369–373CrossRefPubMedGoogle Scholar
  25. 25.
    Mahurkar SD, Meyers L Jr, Cohen J, Kamath RV, Dunea G (1978) Electroencephalographic and radionuclide studies in dialysis dementia. Kidney Int 13(4):306–315CrossRefPubMedGoogle Scholar
  26. 26.
    Sperschneider H, Stein G, Keil E (1993) Concentrations of urea, creatinine and electrolytes in the blood and CSF of patients with progressive dialysis encephalopathy (PDE). In: Nieren-und Hochdruckkrankheiten. Springer, Berlin HeidelbergGoogle Scholar
  27. 27.
    Laurent A: In discussion on dialysis encephalopathy syndrome (1976) Proc 13th Congr Eur Dial Transpi Assoc 13:363Google Scholar
  28. 28.
    Luo S, Qi RF, Wen JQ, Zhong JH, Kong X, Liang X, Xu Q, Zheng G, Zhang Z, Zhang LJ, Lu GM (2016) Abnormal intrinsic brain activity patterns in patients with endstage renal disease undergoing peritoneal dialysis: a resting-state functional MR imaging study. Radiology 278(1):181–189CrossRefPubMedGoogle Scholar
  29. 29.
    Zang YF, He Y, Zhu CZ, Cao QJ, Sui MQ, Liang M, Tian LX, Jiang TZ, Wang YF (2007) Altered baseline brain activity in children with ADHD revealed by resting-state functional MRI. Brain Dev 29(2):83–91.  https://doi.org/10.1016/j.braindev.2006.07.002 CrossRefPubMedGoogle Scholar
  30. 30.
    Stein G, Sperschneider H, Winnefeld K, Gunther K (1991) Desferrloxamine (DFO) in the detection and treatment of aluminum intoxication in dialysis patients. Z Klin Med 46(14):1071–1076Google Scholar
  31. 31.
    D’Haese PC, Couttenye MM, Goodman WG, Lemoniatou E, Digenis P, Sotornik I, Fagalde A, Barsoum RS, Lamberts LV, De Broe ME (1995) Use of the low-dose desferrioxamine test to diagnose and differentiate between patients with aluminium-related bone disease, increased risk for aluminium toxicity, or aluminium overload. Nephrol Dial Transplant 10(10):1874–1884PubMedGoogle Scholar
  32. 32.
    D’Haese PC, Couttenye MM, De Broe ME (1996) Diagnosis and treatment of aluminium bone disease. Nephrol Dial Transplant 11(Suppl 3):74–79CrossRefPubMedGoogle Scholar
  33. 33.
    Bansal VK, Bansal S (2014) Nervous system disorders in dialysis patients. Handb Clin Neurol 119:395–404.  https://doi.org/10.1016/B978-0-7020-4086-3.00025-4 CrossRefPubMedGoogle Scholar
  34. 34.
    Barron J, Whiteley SJ, Horn AC, Ralston AR, Ackrill P (1980) A new approach to the early detection of dialysis encephalopathy. Br J Disord Commun 15(2):75–85CrossRefPubMedGoogle Scholar
  35. 35.
    Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699.  https://doi.org/10.1111/j.1532-5415.2005.53221.x CrossRefPubMedGoogle Scholar
  36. 36.
    Tholen S, Schmaderer C, Kusmenkov E, Chmielewski S, Forstl H, Kehl V, Heemann U, Baumann M, Grimmer T (2014) Variability of cognitive performance during hemodialysis: standardization of cognitive assessment. Dement Geriatr Cogn Disord 38(1–2):31–38.  https://doi.org/10.1159/000357803 CrossRefPubMedGoogle Scholar
  37. 37.
    Tiffin-Richards FE, Costa AS, Holschbach B, Frank RD, Vassiliadou A, Kruger T, Kuckuck K, Gross T, Eitner F, Floege J, Schulz JB, Reetz K (2014) The Montreal Cognitive Assessment (MoCA)—a sensitive screening instrument for detecting cognitive impairment in chronic hemodialysis patients. PLoS One 9(10):e106700.  https://doi.org/10.1371/journal.pone.0106700 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Dunea G, Mahurkar SD, Mamdani B, Smith EC (1978) Role of aluminum in dialysis dementia. Ann Intern Med 88(4):502–504CrossRefPubMedGoogle Scholar
  39. 39.
    Sullivan P, Murnaghan DJ, Callaghan N (1977) Dialysis dementia: recovery after transplantation. Br Med J 2(6089):740CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rosenbek JC, McNeil MR, Lemme ML, Prescott TE, Alfrey AC (1975) Speech and language findings in a chronic hemodialysis patient: a case report. J Speech Hear Disord 40(2):245–252CrossRefPubMedGoogle Scholar
  41. 41.
    Chokroverty S, Gandhi V (1982) Electroencephalograms in patients with progressive dialytic encephalopathy. Clin EEG 13(2):122–127Google Scholar
  42. 42.
    Luda E, Canavese C, Rocca G (1984) The EEG in progressive dialysis encephalopathy. The EEG and clinical indices of PDE in cases treated with desferrioxamine. (Part. II). Ital J Neurol Sci 5(4):375–380CrossRefPubMedGoogle Scholar
  43. 43.
    Sabouraud O, Chatel M, Menault F, Dien Peron J, Cartier F, Garre M, Gary J, Pecker S (1978) Progressive myoclonic encephalopathy in dialysis patients. Clinical, electroencephalographic and neuropathological study. Pathogenetic discussion. Rev Neurol 134(10):575–600PubMedGoogle Scholar
  44. 44.
    Schaul N, Lueders H, Sachdev K (1981) Generalized, bilaterally synchronous bursts of slow waves in the EEG. Arch Neurol 38(11):690–692CrossRefPubMedGoogle Scholar
  45. 45.
    Bugiani O, Brancaccio D, Ghetti B (1985) Progressive dialytic encephalopathy and the problem of aluminum neurotoxicity. Clin Nephrol 24(Suppl 1):S20–S25PubMedGoogle Scholar
  46. 46.
    Alfrey AC (1978) Dialysis encephalopathy syndrome. Annu Rev Med 29:93–98.  https://doi.org/10.1146/annurev.me.29.020178.000521 CrossRefPubMedGoogle Scholar
  47. 47.
    Jack RA, Rivers-Bulkeley NT, Rabin PL (1983) Secondary mania as a presentation of progressive dialysis encephalopathy. J Nerv Ment Dis 171(3):193–195CrossRefPubMedGoogle Scholar
  48. 48.
    Kim DM, Lee IH, Song CJ (2016) Uremic encephalopathy: MR imaging findings and clinical correlation. AJNR Am J Neuroradiol 37(9):1604–1609.  https://doi.org/10.3174/ajnr.A4776 CrossRefPubMedGoogle Scholar
  49. 49.
    Kang E, Jeon SJ, Choi SS (2012) Uremic encephalopathy with atypical magnetic resonance features on diffusion-weighted images. Korean J Radiol 13(6):808–811.  https://doi.org/10.3348/kjr.2012.13.6.808 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Kim TK, Seo SI, Kim JH, Lee NJ, Seol HY (2006) Diffusion-weighted magnetic resonance imaging in the syndrome of acute bilateral basal ganglia lesions in diabetic uremia. Mov Disord 21(8):1267–1270.  https://doi.org/10.1002/mds.20932 CrossRefPubMedGoogle Scholar
  51. 51.
    Seifter JL, Samuels MA (2011) Uremic encephalopathy and other brain disorders associated with renal failure. Semin Neurol 31(2):139–143.  https://doi.org/10.1055/s-0031-1277984 CrossRefPubMedGoogle Scholar
  52. 52.
    Etgen T (2015) Kidney disease as a determinant of cognitive decline and dementia. Alzheimers Res Ther 7(1):29.  https://doi.org/10.1186/s13195-015-0115-4 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Benna P, Lacquaniti F, Triolo G, Ferrero P, Bergamasco B (1981) Acute neurologic complications of hemodialysis. Study of 14,000 hemodialyses in 103 patients with chronic renal failure. Ital J Neurol Sci 2(1):53–57CrossRefPubMedGoogle Scholar
  54. 54.
    Mossuto L, Fattapposta F, Rossi F (1986) Central pontine myelinolysis: diagnosis by computed tomography, magnetic resonance and evoked potentials. Ital J Neurol Sci 7(6):591–596CrossRefPubMedGoogle Scholar
  55. 55.
    Fasano A, Cavallieri F, Mandrioli J, Chiari A, Nichelli P (2018) Central pontine myelinolysis and poorly controlled diabetes: MRI’s hints for pathogenesis. Neurol Sci 39(1):193–195.  https://doi.org/10.1007/s10072-017-3117-0 CrossRefPubMedGoogle Scholar
  56. 56.
    Adams RD, Victor M (1993) Principles of neurology. Mc Graw-Hill, New YorkGoogle Scholar
  57. 57.
    Menger H, Jorg J (1999) Outcome of central pontine and extrapontine myelinolysis (n = 44). J Neurol 246(8):700–705CrossRefPubMedGoogle Scholar
  58. 58.
    Dolciotti C, Nuti A, Cipriani G, Borelli P, Baldacci F, Logi C, Bonuccelli U (2010) Cerebellar ataxia with complete clinical recovery and resolution of MRI lesions related to central pontine myelinolysis: case report and literature review. Case Rep Neurol 2(3):157–162.  https://doi.org/10.1159/000323429 CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Ozgur-Ilhan I, Demirbas H, Yalcin GA, Yucesan C, Dogan YB (2005) Alcoholic case of central pontine myelinolysis with mainly cerebellar signs. Eur Addict Res 11(3):155–156.  https://doi.org/10.1159/000085552 CrossRefPubMedGoogle Scholar
  60. 60.
    Kim J, Song T, Park S, Choi IS (2007) Cerebellar peduncular myelinolysis in a patient receiving hemodialysis. J Neurol Sci 253(1–2):66–68.  https://doi.org/10.1016/j.jns.2006.10.012 CrossRefPubMedGoogle Scholar
  61. 61.
    Tedeschi G, Di Iorio G, Bonavita V (1987) Pathogenesis and prevention of central pontine myelinolysis: a case report. Ital J Neurol Sci 8(2):163–166CrossRefPubMedGoogle Scholar
  62. 62.
    Epperla N, Landeck J, Sabbagh S (2014) Osmotic demyelination syndrome. WMJ 113(5):197–198PubMedGoogle Scholar
  63. 63.
    Murthy SB, Izadyar S, Dhamne M, Kass JS, Goldsmith CE (2013) Osmotic demyelination syndrome: variable clinical and radiologic response to intravenous immunoglobulin therapy. Neurol Sci 34(4):581–584.  https://doi.org/10.1007/s10072-012-1027-8 CrossRefPubMedGoogle Scholar
  64. 64.
    Shigekiyo T, Tani H, Nakajima H, Kimura F (2017) Antecedent diffuse cerebellar lesions on diffusion-weighted MRI in nonalcoholic Wernicke’s encephalopathy. Neurol Sci 39:789–790.  https://doi.org/10.1007/s10072-017-3190-4 CrossRefPubMedGoogle Scholar
  65. 65.
    Celik Y, Kaya M (2004) Brain SPECT findings in Wernicke’s encephalopathy. Neurol Sci 25(1):23–26.  https://doi.org/10.1007/s10072-004-0222-x CrossRefPubMedGoogle Scholar
  66. 66.
    Antunez E, Estruch R, Cardenal C, Nicolas JM, Fernandez-Sola J, Urbano-Marquez A (1998) Usefulness of CT and MR imaging in the diagnosis of acute Wernicke’s encephalopathy. AJR Am J Roentgenol 171(4):1131–1137.  https://doi.org/10.2214/ajr.171.4.9763009 CrossRefPubMedGoogle Scholar
  67. 67.
    Fernandez-Martin JL, Canteros A, Serrano M, Gonzalez-Carcedo A, Diaz-Corte C, Cannata Andia JB (1998) Prevention of aluminium exposure through dialysis fluids. Analysis of changes in the last 8 years. Nephrol Dial Transplant 13(Suppl 3):78–81CrossRefPubMedGoogle Scholar
  68. 68.
    Denizli A, Say R, Pişkin E (2003) Removal of aluminium by Alizarin Yellow-attached magnetic poly(2-hydroxyethyl methacrylate) beads. React Funct Polym 55(1):99–107CrossRefGoogle Scholar
  69. 69.
    Elger CE, Knoll O, Ludolph AC, Raidt H (1987) Therapeutic problems in patients suffering from aluminum encephalopathy. In: Poeck MK, Hacke MW, Schneider MR (eds) Neuroimmunologie Spinale Krankheiten Neuropsychologie Metabolische Enzephalopathien Neurologische Notflle Interventionelle Neuroradiologie. Springer, Berlin HeidelbergGoogle Scholar
  70. 70.
    National Kidney F (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):S1–201Google Scholar
  71. 71.
    Molitoris BA, Alfrey AC, Alfrey PS, Miller NL (1988) Rapid removal of DFO-chelated aluminum during hemodialysis using polysulfone dialyzers. Kidney Int 34(1):98–101CrossRefPubMedGoogle Scholar
  72. 72.
    Seidowsky A, Dupuis E, Drueke T, Dard S, Massy ZA, Canaud B (2018) Aluminic intoxication in chronic hemodialysis. A diagnosis rarely evoked nowadays. Clinical case and review of the literature. Nephrol Ther 14(1):35–41.  https://doi.org/10.1016/j.nephro.2017.04.002 CrossRefPubMedGoogle Scholar
  73. 73.
    Sumiyoshi H, Mantani A, Nishiyama S, Fujiwaki S, Ohta S, Masuda Y, Tomita Y, Tarumoto N, Yamawaki S (2013) Yokukansan treatment of chronic renal failure patients receiving hemodialysis, with behavioral and psychological symptoms of dementia: an open-label study. Am J Geriatr Psychiatry 21(11):1082–1085.  https://doi.org/10.1016/j.jagp.2011.06.001 CrossRefPubMedGoogle Scholar
  74. 74.
    Vinciguerra C (2017) Music intervention efficacy in elderly: a promising non-pharmacological approach to cognitive dysfunctions. Neurol Sci 38(6):933–934.  https://doi.org/10.1007/s10072-017-3011-9 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology, the First Affiliated Hospital of Chongqing Medical UniversityChongqing Key Laboratory of NeurologyChongqingChina
  2. 2.Center of EpilepsyBeijing Institute for Brain DisordersBeijingChina

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