Available online 6 December 2022

: Dialysis disequilibrium syndrome (DDS) is a rare, well-known, potentially life-threatening complication of renal replacement therapy (RRT), often involving cerebral edema and increased intracranial pressure (ICP). However, the impact of RRT on ICP and rate of DDS in neurosurgical patients have not been systematically assessed.

: In February 2022, a systematic review following PRISMA guidelines was conducted using various combinations of 9 keywords in MEDLINE. Eleven papers were selected. Individual patient data were extracted, pooled, and analyzed.

: Fifty-eight patients, 44 men and 14 women with mean age 48 years (6-78), were analyzed. Neurosurgical conditions included: spontaneous intracranial hemorrhage (n=27), traumatic brain injury (n=16), ischemic stroke/anoxic brain injury (n=6), intracranial tumor (n=6), other (n=3). Neurosurgical interventions included: craniotomy/craniectomy (n=23), external ventricular drain or ICP monitor placement (n=16), burr hole or twist drill craniostomy (n=4). Intermittent dialysis was used in 33 patients, continuous RRT in 20, and a combination thereof in 4. During RRT, ICP increased in 35 patients (60.3%), remained unchanged in 20, decreased in 3. Thirty-four patients died. Intermittent dialysis was associated with increased ICP (73% vs. 37.5%, p=0.01) and mortality (75% vs. 39.1%, p=0.01).

: In neurosurgical patients, ICP increases during RRT are common, affecting up to 60%, and potentially life-threatening, with mortality rates as high as 65%. The use of a continuous rather than intermittent RRT technique may reduce the risk of this complication. Prospective studies are warranted.

© 2022 Elsevier Inc. All rights reserved.