Computer methods, uremic encephalopathy, and adequacy of dialysis

• Published in: Kidney international Vol. 24; no. 4; pp. 496 - 506
• Main Authors: Bourne, John R., Teschan, Paul E., Bourne, J R
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.1983
• Subjects: Brain Diseases - diagnosis; Brain Diseases - therapy; Computers; Diagnosis, Computer-Assisted; Electroencephalography; Humans; Renal Dialysis; Software; Uremia - diagnosis; Uremia - therapy
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.1983.186

The symptoms which develop in well-managed patients with acute or chronic progressive renal failure comprise the neurobehavioral syndrome, uremic encephalopathy. Interfering with vigilance, cognitive functions, and ultimately consciousness, these symptoms impose significant disability unless dialysis treatment can reverse and suppress them or a successful renal transplant provides the patient with virtually normal renal function, and, consequently, complete symptomatic recovery. This apparent connection between disability as a neurobeha-vioral “encephalic” disorder and its response to dialysis prompted our attempts to apply quantitative electroencephalogram (EEG) measures as indices of the “toxic encephalopathy” of renal failure and of its response to “standard” dialysis regimens and to transplantation. Subsequent work indicates that EEG measures are sensitive to varying amounts or intensity of maintenance dialysis, to changes in modality of dialysis, for example, the shift from conventional prescriptions of maintenance hemodialysis to peritoneal dialysis, CAPD, CCPD, and so forth, or to effects within individual dialysis sessions in cases of dialysis disequilibrium. These findings invite the prospect that one may objectively assess at least the relative adequacy of different levels and modalities of dialysis in individual patients using objective indices which are particularly relevant both to the symptomatic disability of renal failure on one hand, and to the symptomatic improvement evoked by dialysis on the other. Therefore, in this article we describe the use of computer-based methods for the evaluation of uremic encephalopathy and its response to treatment. Examples are given in which such computerized evaluations have guided decisions about treatment, particularly to assure sufficient dialysis to suppress even the milder manifestations of the dialysis-responses, clinical uremic syndrome. The purpose of the article is to dispel the mystique that has surrounded the use of the computer for evaluation of EEGs recorded from renal patients. The methods described below were designed specifically for use with EEGs recorded from renal patients and should not be considered as a replacement for a trained EEG scorer. Visual scoring of the EEG provides a comprehensive examination of an EEG record that is unlikely ever to be matched by any computer program. Hence, the methods described should be viewed simply as a quantitative evaluation tool for a limited range of significant features in EEGs secured from a rather select population. We hope the practical information given can be used to guide physicians as they begin to incorporate the methods described into their everyday practice. A survey of the history of the use of computers in the evaluation of electroencephalograms recorded from patients with renal disorders is given as well as a critical evaluation of computer methods employed in past approaches. The practical consequences of a decision to utilize computerized testing methods will be examined. A prospectus that attempts to highlight possible future directions in this area completes the paper.