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Renal Replacement Therapy and Dialysis-associated Neurovascular Injury (DANI) in the Neuro ICU: a Review of Pathophysiology and Preventative Options

  • Critical Care Neurology (H Hinson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of Review

Dialysis-associated neurovascular injury (DANI) is a significant contributor to secondary neurologic injury for patients with acute brain injury undergoing renal replacement therapy (RRT). This manuscript reviews the multi-faceted pathophysiologic aspects of DANI and focuses on options for neuro-monitoring and RRT prescription modification to prevent DANI.

Recent Findings

We consider DANI a clinical syndrome encompassing cerebral edema, impaired cerebral blood flow, and cerebrospinal fluid metabolic alterations during RRT, all of which may lead to secondary brain injury. Neurological monitoring in dialysis, particularly non-invasive methods such as near-infrared spectroscopy and transcranial Doppler ultrasonography, are emerging tools for dialysis medicine in acute brain injury and DANI prevention. Treatment options such as dialysate sodium modeling, limited solute clearance, weight-based ultrafiltration rates, cooled dialysate, and combination ultrafiltration and dialysis treatments may be helpful in limiting secondary neurologic injury from DANI.

Summary

This manuscript is intended to inform neurocritical care providers about components of DANI pathophysiology, and potential preventative and treatment strategies for at-risk patients.

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  1. Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Shivani Ghoshal MD

  2. Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Barry I. Freedman MD

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Ghoshal, S., Freedman, B.I. Renal Replacement Therapy and Dialysis-associated Neurovascular Injury (DANI) in the Neuro ICU: a Review of Pathophysiology and Preventative Options. Curr Treat Options Neurol 23, 5 (2021). https://doi.org/10.1007/s11940-020-00661-1

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