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Dialysis Disequilibrium Syndrome (DDS) is an unusual but serious complication that can happen during or soon after haemodialysis, especially in those who are new to dialysis or have high uremia. It happens when urea and other solutes are quickly taken out of the blood, which makes an osmotic gradient between the brain and plasma. This gradient makes water migrate into brain cells, which causes cerebral oedema and neurological symptoms.

Clinically, DDS manifests as headache, nausea, vomiting, restlessness, impaired vision, muscle cramps, confusion, and, in severe instances, seizures or coma. It is more likely to happen to those who are having their first few dialysis treatments or when dialysis is done too vigorously.

To stop rapid solute changes, prevention focuses on starting dialysis slowly and gently, having shorter sessions, and lowering blood flow rates. Giving mannitol or hypertonic saline may help bring down swelling in the brain.

It's crucial to find and treat severe DDS early, as it can be life-threatening. Dialysis Disequilibrium Syndrome is now significantly less likely to occur due to improved methods of prevention and patient monitoring. This makes modern dialysis safer and easier for people with severe kidney failure.