New Insights into Dialysis Disequilibrium Syndrome: A Retrospective Study

By: Andrea Estrella

A senior at Fordham College at Rose Hill, Andrew Parsons is a biology major on the pre-med track. He is an active member of the Fordham community, serving on the executive board of Fordham’s Engineers Without Borders chapter and playing on the scout squad for the women’s basketball team. Off campus, he volunteers with City Squash, an after-school athletic program in the Bronx. 

Parsons first became involved with undergraduate research in the summer of 2019 while shadowing Dr. Ralph Rahme, the head neurosurgeon at St. Barnabas Hospital. His research took the form of a retrospective cohort study that aimed to compile existing data and case studies to provide insight into Dialysis Disequilibrium Syndrome (DDS), a neurological disorder affecting patients undergoing dialysis treatment. The disorder is characterized by various neurological symptoms attributable to cerebral edema, the accumulation of fluid within the brain. Because the condition has not been comprehensively researched, its exact cause is still not well understood. Due to the wide range in severity of its symptoms, DDS is likely highly underreported among patients who experience mild symptoms, pointing to the critical need for further research.

Through a retrospective study, Parsons aimed to elucidate certain aspects of the disorder, and he ultimately hoped to provide the frameworks for further study of DDS patients at St. Barnabas. 

In the first few months of his time at St. Barnabas, Parsons focused mainly on foundational research to deepen his own understanding of the condition and relevant terminology. Though he noted that there was initially a steep learning curve, he was soon able to get up to speed. After completing this groundwork, he went on to research every reported incidence of DDS he could find, some dating back to the early 1900s. From these reports, he extracted relevant medical data such as age, sex, blood pressure, and neurosurgery. He then compiled this information into a table which he used to run statistical analyses regarding mortality and recovery rates. By cross-referencing these statistics, he hoped to identify patterns that would provide insight into risk factors and treatment effectiveness.

His research produced several significant findings. First, he found that patients who received continuous dialysis treatment had much higher survival rates than those who received intermittent dialysis. Based on this finding, the study recommends continuous over intermittent dialysis. He also found that, once they develop, the effects of DDS are extremely difficult to reverse, highlighting the importance of identifying at-risk patients and taking preventative treatment measures. Lastly, he found that patients with a kidney disorder and a neurological disorder are at an especially high risk of developing DDS. These findings provide critical insight that will aid medical professionals in identifying and treating at-risk patient demographics. 

In retrospect, Parsons noted that the most rewarding part of his research was finding statistically significant data. He recalled being very excited to come across patterns in the data that had notable implications, explaining, “As far as I’m concerned, it actually matters.” 

In the spring, Parsons’ findings were accepted to the American Association of Neurological Surgeons. He was invited to present the research at a panel, which was unfortunately canceled due to safety concerns surrounding the COVID-19 pandemic. Nonetheless, he is currently working with Dr. Rahme to finalize his papers and plans to pursue publication. Through his research, Parsons has certainly made a significant contribution to the medical community even prior to formally entering it.

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