I used to hear about this back in med school, but it doesn't happen much anymore, in this era of earlier initiation of dialysis.
One of the mechanisms is the osmotic effect of urea. Ordinarily urea is an “ineffective osmole.” That changes when large amounts are cleared rapidly from the blood. Water can move into the brain faster than urea can move out.
There's an interesting post on this at Renal Fellow Network.
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