Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Donati, Gabriele; Ursino, Mauro; Spazzoli, Alessandra; Natali, Nicolò; Schillaci, Roberto; Conte, Diletta; Angeletti, Andrea; Chiocchini, Anna Laura Croci; Capelli, Irene; Baraldi, Olga; Manna, Gaetano La

doi:10.1159/000480221

Cited by 7 publications

(7 citation statements)

References 37 publications

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“…The system that uses sodium sensor in hemofiltration with endogenous reinfusion is called hemodiafiltration Aequilibrium (HFR-Aeq). 47 In a randomized crossover multinational study, Locatelli et al reported that significantly less symptomatic IDH was seen in HFR-Aeq, and the effect was significantly greater in unstable patients. No evidence of sodium or water overload was detected with the intervention.…”

Section: Sodium Profiling As a Part Of Dialysis Modalities And Biofeedbackmentioning

confidence: 99%

“…These models use real‐time data from patients and are being used to reach end‐dialysis sodium, weight, and blood volume targets. Such biofeedback systems enable to achieve sodium balance neutral sodium profile and UF profile automatically 47–49 . Currently, there are various commercial dialysis systems that calculate dialysate and UF profiles with algorithms based on the prescribed decrease in body weight and sodium mass 50 …”

Section: Sodium Profilingmentioning

confidence: 99%

“…The application of real‐time sodium sensor (Natrium sensor) in biofeedback further enables recalculation and adjustment of the sodium profile and ultrafiltrate conductivity during the dialysis session. The system that uses sodium sensor in hemofiltration with endogenous reinfusion is called hemodiafiltration Aequilibrium (HFR‐Aeq) 47 . In a randomized crossover multinational study, Locatelli et al reported that significantly less symptomatic IDH was seen in HFR‐Aeq, and the effect was significantly greater in unstable patients.…”

Section: Sodium Profiling As a Part Of Dialysis Modalities And Biofee...mentioning

confidence: 99%

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Sodium and ultrafiltration profiling in hemodialysis: A long‐forgotten issue revisited

Ertuğlu

Demiray

Basile

et al. 2021

Hemodialysis International

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Sodium and ultrafiltration profiling are method of dialysis in which dialysate sodium concentration and ultrafiltration rate are altered during the course of the dialysis session. Sodium and ultrafiltration profiling have been used, commonly simultaneously, to improve hemodynamic stability during hemodialysis. Sodium profiling is particularly effective in decreasing the incidence of intradialytic hypotension, while ultrafiltration profiling is suggested to decrease subclinical repeated end organ ischemia during dialysis. However, complications such as increased interdialytic weight gain and thirst due to sodium excess have prevented widespread use of sodium profiling. Evidence suggest that different sodium profiling techniques may lead to different clinical results, and preferring sodium balance neutral sodium profiling may mitigate adverse effects related to sodium overload. However, evidence is lacking on the long-term clinical outcomes of different sodium profiling methods. Optimal method of sodium profiling as well as the utility of sodium/ultrafiltration profiling in routine practice await further clinical investigation.

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Section: Sodium Profiling As a Part Of Dialysis Modalities And Biofeedbackmentioning

confidence: 99%

Section: Sodium Profilingmentioning

confidence: 99%

Section: Sodium Profiling As a Part Of Dialysis Modalities And Biofee...mentioning

confidence: 99%

See 1 more Smart Citation

Sodium and ultrafiltration profiling in hemodialysis: A long‐forgotten issue revisited

Ertuğlu

Demiray

Basile

et al. 2021

Hemodialysis International

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“…Good agreement is reported between natremia measured by a laboratory device (Na Lab ) and plasma-water conductivity (Γ P ) with a correlation coefficient of about 0.9 (range 0.77-0.97) depending on the method of measurement for plasma sodium and plasma-water conductivity. 4,5,[8][9][10][11][12][13][14][15] The Na Lab /Γ P ratio is very close to 10 (mmol/L)/(mS/cm) in the usual range of values (Table 1), so the Γ P value (mS/cm) can be converted to an online natremia value (mmol/L) before being displayed on the screen of some hemodialysis machines. 16,17 Although the concentration of cations other than sodium (mainly potassium) can be neglected relative to sodium concentration (5% vs. 95%), the variation in their plasma concentration during a dialysis session cannot be neglected relative to the variation of natremia.…”

Section: Conductivity and Sodium In Dialysis Fluidmentioning

confidence: 99%

Dialysate sodium management in hemodialysis and online hemodiafiltration: The single‐pool kinetic model revisited

Petitclerc

2022

Artificial Organs

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Background Determining the optimal dialysate sodium remains one of the challenges of hemodialysis prescription. Several arguments suggest that the dialysate sodium should be individually adjusted according to the patient's natremia. This strategy is greatly facilitated by using an algorithm. Only three such algorithms have been embedded in hemodialysis machines for the widespread generalization of this strategy in clinical routine: the Diacontrol (Hospal‐Baxter Healthcare Corp., Deerfield, IL, USA), the HFR‐Aequilibrium (Bellco‐Medtronic, Dublin, Ireland), and the Na‐control (Fresenius Medical Care, Bad‐Homburg, Germany). Methods Model the solute mass‐transfer across the dialyzer membrane in online hemodiafiltration and adapt the Diacontrol algorithm based on a single‐pool kinetic model of sodium balance for quantifying ionic balance and managing tonicity. Results (1) Substituting sodium measurements with conductivity measurements allows the control of tonicity which is a more physiological parameter than natremia. (2) Consideration of all ion exchanges as a whole and not just sodium exchange avoids some of the assumptions required by kinetic modeling of sodium balance. (3) Equations provided by the model are applicable to both hemodialysis and online hemodiafiltration. (4) The differences between this model used by Diacontrol and the models on which the other two software's (HFR‐Aequilibrium and Na‐control) are based are highlighted. Conclusions The single‐pool kinetic model developed for the management of natremia in hemodialysis is also valid for the management of tonicity for both conventional hemodialysis and all online hemodiafiltration procedures.

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“…As sodium is the predominant ion in both plasma and dialysate, then conductivity measurements can be used to estimate sodium activity. Thus, by measuring conductivity in both plasma an dialysate, then dialysate sodium can be adjusted accordingly to achieve isonatric dialysis 28 . Preliminary studies have reported that this automatic adaptive technology reduced the number of hypotensive dialysis sessions complicated by IDH 29 .…”

Section: Dialysate Sodiummentioning

confidence: 99%

Reducing the risk of intradialytic hypotension by altering the composition of the dialysate

Vareesangthip

Davenport

2020

Hemodialysis International

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Hypotension is the most common complication of outpatient hemodialysis sessions, with a reported prevalence of 4% to 31%, depending on which definition has been used and whether patients are symptomatic and nursing interventions were required. Dialysis centers which mix the dialysate in the dialysis machine have the opportunity to individualize the composition of the dialysate for patients. This permits a choice of dialysate sodium, potassium, calcium, magnesium, bicarbonate, acetate, and citrate concentrations and temperature. Studies have reported a higher intradialytic systolic blood pressure and fewer episodes of intradialytic hypotension when using a higher dialysate sodium, calcium, magnesium concentrations and lower temperature, but no clinical advantage for changing the potassium, bicarbonate, or citrate for acetate concentrations. The introduction of newer technology allowing real time measurements of plasma electrolyte concentrations will potentially allow changing the dialysate composition to reduce the risk of intradialytic hypotension without increasing the risk of positive electrolyte balances.

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Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Cited by 7 publications

References 37 publications

Sodium and ultrafiltration profiling in hemodialysis: A long‐forgotten issue revisited

Sodium and ultrafiltration profiling in hemodialysis: A long‐forgotten issue revisited

Dialysate sodium management in hemodialysis and online hemodiafiltration: The single‐pool kinetic model revisited

Reducing the risk of intradialytic hypotension by altering the composition of the dialysate

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