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In a patient with acute brain injury, IHD may worsen neurological status by compromising cerebral perfusion pressure. This may be the result of a decrease of mean arterial pressure (dialysis-induced hypotension) or an increase of cerebral edema and intracranial pressure (dialysis disequilibrium), and may jeopardize the potential for neurologic recovery. Dialysis disequilibrium results from the rapid removal of solutes, resulting in intracellular fluid shifts. Both hypotension and disequilibrium can be avoided by the slow progressive removal of fluids and solutes that occurs during CRRT.729 Small observational trials and case reports in patients with intracranial pressure monitoring indeed reported increases in intracranial pressure with IHD.730,731 Using CT scans to measure brain density, Ronco et al.732 showed an increase of brain water content after IHD, whereas no such changes were observed after CRRT.
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