Excessive sodium gain is a major hindrance of sodium profiling hemodialysis (HD) that offsets the benefit in reducing intradialytic hypotension-related discomforts (IHD). Patients who showed frequent IHD (>30% of the sessions; n ‫؍‬ 11) were enrolled in a prospective study that consisted of two phases. In the phase 1 study, eight treatment modalities were evaluated: Conventional HD (control), sodium balance-positive step-down sodium profiling HD (PS), sodium balance-neutral stepdown sodium profiling HD (NS), sodium balance-neutral alternating sodium profiling HD (NA) without ultrafiltration (UF) profile, and all those with UF profile (UF only, PS؉U, NS؉U, and NA؉U). The incidences of "dialysis failure," defined as the occurrence of one or more of (1) session failure (discontinuation of session <75% of planned time), (2) UF failure (%UF achieved <70%), and (3) delivery failure (Kt/V <1.1), were 48.5, 21.2, 42.4, 39.4, 45.5, 18.2, 21.2, and 18.2% in control, PS, NS, NA, UF only, PS؉U, NS؉U, and NA؉U, respectively. Four treatments, PS, PS؉U, NS؉U, and NA؉U, reduced the incidence of dialysis failure significantly as compared with control (P < 0.05) and were evaluated in the phase 2 study, a randomized controlled 6-wk crossover study. Parameters were measured in the steady state after a 6-wk maintenance of each treatment. Diffusive sodium gain (⌬Na) was significantly increased with sodium balance-positive profiles with or without UF profile, PS and PS؉U (PS 1.9 ؎ 1.1, PS؉U 1.7 ؎ 1.0 mEq/L; both P < 0.05 to control ؊0.1 ؎ 0.2, NS؉U 0.5 ؎ 0.4, NA؉U 0.4 ؎ 0.2 mEq/L). They also increased the interdialytic weight gain (PS 3.8 ؎ 0.6, PS؉U 4.0 ؎ 0.6 kg; both P < 0.05 to control 2.7 ؎ 0.6, NS؉U 3.3 ؎ 0.6 kg; both P ‫؍‬ NS to NA؉U 3.5 ؎ 0.6 kg). Predialysis weight and the required amount of UF also increased significantly with these sodium balance-positive profiles. Although the absolute amount of UF was larger with PS and PS؉U, %UF achieved targeting dry weight was higher with sodium balance-neutral profiles with UF profiles, NS؉U and NA؉U (NS؉U 92.7 ؎ 3.8, NA؉U 93.7 ؎ 6.8%; both P < 0.05 to control 72.6 ؎ 14.0, PS 88.3 ؎ 6.6, PS؉U 88.2 ؎ 8.2%). Postdialysis weight was closest to dry weight with these treatments showing ⌬ (postdialysis weight ؊ dry weight) of 0.3 ؎ 0.1 and 0.3 ؎ 0.2 kg in NS؉U and NA؉U (both P < 0.05 to control 1.0 ؎ 0.6 kg; both P ‫؍‬ NS to PS 0.5 ؎ 0.3, PS؉U 0.5 ؎ 0.4 kg). Incidence of excessive weight gain and subjective discomforts during the interdialytic period increased significantly with PS. In conclusion, continuous use of sodium balance-positive sodium profiles resulted in an undesirable steady state with sodium and fluid expansion offsetting their hemodynamic benefit. Sodium balance-neutral sodium profiles in combination with UF profile were associated with less sodium and weight gains, better UF performance with postdialysis weight closest to dry weight, and fewer interdialytic problems with the equivalent hemodynamic benefit. Therefore, it is proposed that sodium balance-neutral sodium profiling...

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Currently available TBW equations overestimate TBW in both Korean normal control subjects and HD patients. Among them, the Watson formula appears to be the closest to TBW and to have the least bias. Based on this analysis, it is reasonable to use the Watson formula for the calculation of TBW in Korean adult control and HD subjects until an Asian-based TBW equation is available.

Objective To evaluate actual risk of complications and 1-year catheter survival of immediate full-volume 2000-mL dialysate exchange after peritoneal catheter implantation. Design and Setting A prospective randomized comparative study in a university hospital kidney center. Patients The study included 59 end-stage renal disease patients entering into a continuous ambulatory peritoneal dialysis program between January 1996 and December 1997. Interventions In group 1 ( n = 21), exchange volume was gradually increased from 500 mL per 3 hours to full-volume exchange over 13 days. In group 2 ( n = 38), full-volume exchange per 6 hours was performed from the day of catheter implantation. Bed rest with minimal activity was recommended for the first 3 days in both groups. Main Outcome Measures Occurrence of catheter-related complications such as dialysate leakage, drainage failure, malposition, infectious complications, and, ultimately, catheter loss were observed for 1 year. Results After straight Tenckhoff catheter implantation, pericatheter dialysate leaks occurred in 9.5% of group 1 and in 10.5% of group 2 patients (no significance, NS). Within 1 month of implantation, the incidences of tunnel or exit-site infection, catheter malposition, and outflow failure were not significantly different between the two groups. Abdominal discomfort was noted in 2 patients from group 2. Peritonitis occurred in 9.5% and 5.3% (NS) within 2 weeks of catheter implantation, and in 14.3% and 10.5% (NS) after more than 2 weeks in group 1 and group 2, respectively. Early catheter loss within 1 month occurred in 4.8% of patients in group 1 and 5.3% in group 2 (NS). The causes of loss were persistent leakage in group 1, and persistent leakage combined with tunnel infection and outflow failure in group 2. The duration of hospitalization from the day of catheter insertion to discharge was definitely shorter in group 2 compared to group 1 (9.9 ± 0.6 days vs 15.0 ± 0.8 days, p < 0.001). For 1-year follow-up, the frequencies of peritonitis were 0.062 ± 0.015/patient-month in group 1 and 0.076 ± 0.018/patient-month in group 2 (NS). The actual 1-year catheter survival was 85.7% in group 1 and 84.2% in group 2 (NS). Conclusions One-year catheter survival after immediate full-volume peritoneal dialysis exchange was 84.2%. This study did not show any evidence that immediate full-volume exchange causes more short- or long-term complications compared to the stepwise volume increment method.