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Dialysis dementia — Clinical Guidelines

Overview

Dialysis dementia is a severe neurological syndrome observed in a subset of dialysis patients, characterized by progressive cognitive decline and neurological deficits 5 6.

Diagnosis

Clinical presentation includes progressive cognitive impairment and neurological symptoms 5 6.

No specific diagnostic tests are universally recommended; diagnosis is primarily clinical 5 6.

Management

No specific pharmacological treatments are highlighted in the provided abstracts 5 6.

Focus on managing underlying vascular access issues to prevent complications that may contribute to neurological decline 1 2.

Special Populations

No specific considerations for pregnancy, pediatrics, elderly, or comorbidities directly addressed in the abstracts 4 5 6.

Key Recommendations

Prioritize endovascular techniques for managing thrombosed arteriovenous fistulas (AVFs) and grafts when feasible, reserving surgical intervention for cases involving anastomotic stenoses 1 2 (Evidence: Moderate).

Encourage proficiency in percutaneous procedures among local vascular surgeons and interventional radiologists to minimize open surgical interventions 2 (Evidence: Expert opinion).

Monitor and manage vascular access complications rigorously to potentially mitigate factors contributing to dialysis-associated neurological syndromes 1 5 (Evidence: Moderate).

References

1 Fonseca AV, Toledo Barros MG, Baptista-Silva JC, Amorim JE, Vasconcelos V. Interventions for thrombosed haemodialysis arteriovenous fistulas and grafts. The Cochrane database of systematic reviews 2024. link 2 Jorge Cabrera V, Brewster UC. We Send Thrombosed AV Accesses to the Operating Room. Seminars in dialysis 2016. link 3 Stavas JM, Smith TP, DeLong DM, Miller MJ, Suhocki PV, Newman GE. Radiation hand exposure during restoration of flow to the thrombosed dialysis access graft. Journal of vascular and interventional radiology : JVIR 2006. link 4 Vas SI. Infections related to prosthetic materials in patients on chronic dialysis. Minerva urologica e nefrologica = The Italian journal of urology and nephrology 2004. link 5 Lang SM, Henry AC. The pathogenesis of dialysis dementia. Journal of dialysis 1979. link 6 Barratt LJ, Lawrence JR. Dialysis-associated dementia. Australian and New Zealand journal of medicine 1975. link

Dialysis dementia