Dialysis removes waste and excess fluid from the blood when kidneys fail. A seizure is a sudden, uncontrolled electrical disturbance in the brain, causing changes in behavior, movements, feelings, or consciousness. While seizures during dialysis can be a concern, they are not an inevitable outcome for everyone. This article explores how dialysis can directly contribute to seizures and other factors that may increase a patient’s susceptibility.
How Dialysis Can Directly Cause Seizures
Dialysis can directly trigger seizures due to rapid changes in the body’s internal environment. A primary cause is Dialysis Disequilibrium Syndrome (DDS), where solutes are removed from the blood faster than from the brain. This creates an osmotic gradient, causing water to shift into brain cells, leading to cerebral edema. The increased pressure can then manifest as seizures.
Rapid shifts in electrolyte levels during dialysis can also disrupt normal brain function. For instance, a swift correction of low sodium levels (hyponatremia) or rapid removal of calcium can alter the electrical stability of neurons. These changes can make brain cells overly excitable, increasing seizure risk.
Sudden and significant fluid removal can lead to a sharp drop in blood pressure, known as hypotension. This reduction can decrease blood flow to the brain, causing a lack of oxygen. Brain cells deprived of oxygen can become dysfunctional, triggering a seizure.
Other Factors Increasing Seizure Risk in Dialysis Patients
Several factors related to kidney failure can increase a patient’s susceptibility to seizures. The accumulation of toxins in the body due to impaired kidney function, known as uremia, can lead to uremic encephalopathy. This brain dysfunction increases seizure susceptibility.
Uncontrolled high blood pressure is common in individuals with kidney disease. Elevated blood pressure can damage brain blood vessels, leading to conditions like hypertensive encephalopathy or stroke. Both can significantly increase seizure risk.
Kidneys clear many medications from the body. In kidney failure, drugs can accumulate to toxic levels if dosages are not adjusted. Certain medications, including some antibiotics, pain medications, and even anti-seizure drugs, can induce seizures if levels become too high. Healthcare providers adjust medication regimens to prevent accumulation.
Patients undergoing dialysis may also have pre-existing neurological conditions that increase seizure vulnerability. Conditions like epilepsy, stroke, or other neurological disorders can lower the seizure threshold. Physiological stresses from chronic kidney disease and dialysis can further exacerbate these vulnerabilities.
What to Do About Seizures and Prevention
Patients and caregivers should recognize seizure signs. These include confusion, staring spells, sudden jerking movements, or temporary loss of consciousness. If a seizure is suspected, seek immediate medical attention. Evaluation helps determine the cause and guide management.
If someone experiences a seizure, protect them from injury by moving objects away and cushioning their head. Time the seizure to provide accurate information to medical professionals. Do not restrain the person or place anything in their mouth.
Healthcare teams minimize seizure risk in dialysis patients through various strategies. These include initiating dialysis gradually and adjusting treatment parameters like slower blood flow rates and less aggressive fluid removal. Close monitoring of electrolyte levels and blood pressure is also a priority. Medication dosing is tailored to kidney function. Open communication between patients and providers about new symptoms is encouraged.