E–Pearl of the Week: Renal replacement therapy can affect intracranial pressure

February 7, 2012


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February 7, 2012

Renal replacement therapy can affect intracranial pressure

Hemodialysis has been implicated in the development of cerebral edema and intracranial hypertension in susceptible patients. A rapidly developing osmotic gradient between brain extracellular fluid and plasma is thought to be the key mediator. Preliminary evidence suggests that hemodialysis is associated with impaired cerebral autoregulation in comatose patients with acute brain injury.  Continuous forms of renal replacement therapy may confer improved hemodynamic stability and more intact autoregulation. Thus continuous forms may be better tolerated in patients with acute brain injury at risk for intracranial hypertension.


1.  Ko S, Choi HA, Gilmore E, et al. The effects of renal replacement on cerebral autoregulation. Neurology 2012; 78: e36–e38.

2. Silver SM, Sterns RH, Halperin ML. Brain swelling after dialysis: old urea or new osmoles? Am J Kidney Dis 1996; 28: 1–13.

Submitted by: Jennifer E. Fugate, D.O.

Disclosures: Dr. Fugate serves on the editorial team for the Neurology® Resident and Fellow Section.

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