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July 25, 1980

Dialysis Encephalopathy in Peritoneal Dialysis

Author Affiliations

From the Departments of Neurology (Drs Smith, Lewis, and Burks) and Medicine (Dr Alfrey), University of Colorado Health Sciences Center, Denver.

JAMA. 1980;244(4):365-366. doi:10.1001/jama.1980.03310040047028

AN UNCOMMON but distinct syndrome of progressive encephalopathy occurs in association with long-term hemodialysis. Whether long-term peritoneal dialysis poses a similar hazard has received scant attention. The following case report is thereby of interest.

Report of a Case  A 48-year-old, right-handed man with familial amyloidosis began at-home peritoneal dialysis in February 1975, using an automatic cycling apparatus with a builtin reverse osmosis module. Despite renal insufficiency and peripheral neuropathy, he was an active, successful businessman.In January 1977, he experienced transient (36 hours) numbness of the right side. Neurological examination disclosed right-sided sensory extinction but no other acute change. Intellect and language were normal. Brain scan, computerized tomographic (CT) scan, results of lumbar puncture and coagulation studies, echocardiogram, and carotid ultrasonography were normal; an EEG showed intermittent left temporal delta activity; and left carotid angiography suggested an early draining vein near the superior temporal gyrus, presumably reflecting local ischemia.The