CLINICAL AND EXPERIMENTAL STUDY ON THE HEMODIALYSIS

WITH SPECIAL REFERENCE TO THE DIALYSIS DISEQUILIBRIUM SYNDROME

Abstract

Since August 1965, 166 hemodialyses have been performed on 36 patients with renal failure at the Department of Urology, Osaka University Hospital.
Dialyser is Kolff-Twin-Coil type (Junken) and dialysate constituents are as follows: Na 126mEq/L, K 2.6mEq/L, Ca 3.6mEq/L, HCO₃ 24mEq/L, Glucose 2g/dl.
BUN, creatinine, potassium and inorganic phosphate decreased effectively after 6-hour-dialysis.
In 91-hemodialysis-series performed on 9 patients treated over 1 month duration, nausea, vomiting and general fatigue occurred in high incidence and convulsion and coma were also met in some cases.
To study the biochemical changes of body fluids caused by hemodialysis, thoracic duct drainage and hemodialysis were performed on the dogs, which were nephrectomised bilaterally 48 hrs. prior to the procedure.
Serum and lymph were collected serially during 3-hour-dialysis and cerebrospinal fluid was obtained by the suboccipital puncture at the end of dialysis.
On these samples, urea-nitrogen, creatinine, sodium, potassium, chloride and osmolarity were studied.
Biochemical changes of thoracic duct lymph during hemodialysis were very similar to those of serum.
Concentration of urea-nitrogen in cerebrospinal fluid was lower than that of serum before hemodialysis, but was higher at the end of dialysis.
However, osmotic gradient was not found between serum and cerebrospinal fluid.
Following clinical study on the changes of blood glucose level and serum osmolarity, induced transient hyperglycemia during hemodialysis might compensate the osmotic gradient between serum and cerebrospinal fluid.
Considering the relatively higher incidence of dialysis-related neurological symptoms, hyperosmolarity caused by the hyperglycemia must play an important role of the origin for so-called “disequilibrium syndrome”, when high-glucose concentration is applied in the rinsing fluid.