A Simple Mathematical Model of Intradialytic Sodium Kinetics: <i>“in vivo”</i> Validation During Hemodialysis with Constant or Variable Sodium

Ursino, Mauro; Colì, L.; Manna, Gaetano La; Cicilioni, M. Grilli; Dalmastri, Vittorio; Giudicissi, A.; Masotti, P.; Avanzolini, G.; Stefoni, Sergio; Bonomini, V.

doi:10.1177/039139889601900704

Cited by 20 publications

(20 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, clinical and the laboratory signs of sodium accumulation were reported in several (but not all) studies. [3,4,9,10,17] Individualization of the sodium profiling with regard to the predialysis plasma sodium concentration was shown to improve fluid balance gain and dialysis-induced symptoms in specific patients. [10,17] An effect on the blood pressure was noted only in patients with uncontrolled hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…[9,10] According to the proposed model, the sodium elimination during dialysis (J Na ) can be expressed as:…”

Section: Methodsmentioning

confidence: 99%

“…We used plasma sodium as representative of extracellular sodium concentration without correction for plasma water fraction and the Donnan effect, as previously shown. [9,10] Measurements of the blood pressure during dialysis, digitally determined every 20 minutes, were compared with those obtained manually using a sphygmomanometer and were recorded for each dialysis. During hypotensive episodes, blood pressure was measured by two different nurses and electronically recorded every 5-10 minutes.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

et al. 2008

View full text Add to dashboard Cite

Background. Autonomic nervous system dysfunction and dialysate sodium (Na) concentration are believed to play a role in the pathogenesis of hemodialysis-related hypertension. The present study was undertaken to determine whether increases in blood pressure in hemodialysis patients are associated with changes in heart rate variability (HRV), a measure of the autonomic nervous system function, and long-term exposure to increased dialysate Na concentration. Methods. Baseline clinical, biochemical data and HRV of patients undergoing increased Na profiling dialysis (High-Na, n = 9) and on conventional treatment (Control, n = 11) were compared with those obtained after one year of study. Results. After one year, the mean predialysis systolic blood pressure (SBP) increased in seven patients of the High-Na and in five of the Control group, and decreased or remained unchanged in the remaining subjects. Initial HRV was significantly higher in patients with increased SBP, and it increased further in these patients after one year. At the end of the study, post-dialysis plasma Na, osmolality, and weight gains were significantly higher in the High-Na group. No significant correlation, however, was found between individual changes in intradialytic sodium elimination and the alterations in blood pressure. Conclusion. These data suggest that the dialysate sodium concentration, a most important determinant of interdialytic weight gain and fluid balance, is only partly correlated with longterm changes in blood pressure. An increased blood pressure over time may develop in a subset of hemodialysis patients with higher HRV, suggestive of increased sympathetic activity.

show abstract

Section: Discussionmentioning

confidence: 99%

“…[9,10] According to the proposed model, the sodium elimination during dialysis (J Na ) can be expressed as:…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

et al. 2008

View full text Add to dashboard Cite

show abstract

“…We elaborated the sodium profile beforehand, in relation to the patient’s clinical needs, the individual sodium mass removal, and weight gain, by using the mathematical model suggested by Ursino et al [13]. We also considered the Gibbs-Donnan coefficient for optimization of sodium balance during hemodialysis.…”

Section: Methodsmentioning

confidence: 99%

Sodium and Fluid Modulation in Dialysis: New Approach

Splendiani

Costanzi²,

Passalacqua³

et al. 2001

Nephron

View full text Add to dashboard Cite

Hypotension during hemodialysis is still an unsolved problem. The treatment of patients with cardiovascular instability is efficaciously carried out with the use of ‘profiled dialysis’ (PD) with computerized modulation of ultrafiltration and conductivity. We tested a new profile model which involves progressive decrease of ultrafiltration associated with variable conductivity (‘bell pattern’). We observed 8 stable long-term patients receiving hemodialysis (4 men and 4 women, mean age 63.5 years) for 4 h three times a week. Before our test, sodium balance had reached a steady state in all patients and remained stable during the entire observation period. The sodium balance was established by means of a simple pattern suggested by Ursino and coworkers. The patients were observed for two periods of 1 month each (protocols A and B). The intradialytic mean arterial pressure was studied, checking every hour of dialysis. Statistical analysis was done by ANOVA for repeated measures. We compared standard dialysis with constant ultrafiltration rate and conductivity (protocol A) with sessions performed involving a progressive decrease of ultrafiltration together with a variable conductivity of –0.2, +0.2, +0.6, +0.6, 0, –0.4, –0.4, and –0.4 mS/s (protocol B). We found a lower incidence of hypotension (p < 0.01) with better cardiovascular stability during and after treatment in ‘profiled dialysis’.

show abstract

“…This enabled us to predict a priori the intradialytic time pattern of some variables such as sodium mass removal, plasma sodium concentration and extracellular/intracellular (V e /V i ) volume ratio [1]. This first step of the mathematical model was validated experimentally: the validation showed a good fit between model predictions and in vivo curves of plasma sodium and plasma urea concentrations [1,2].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Intradialytic Solute and Fluid Kinetics

Colì

Ursino²,

Pascalis³

et al. 2000

Blood Purif

Self Cite

View full text Add to dashboard Cite

A mathematical model of solute kinetics for the improvement of hemodialysis treatment is presented. It includes a two-compartment description of the main solutes and a three-compartment model of body fluids (plasma, interstitial and intracellular). The main model parameters can be individually assigned a priori, on the basis of body weight and plasma concentration values measured before beginning the session. Model predictions are compared with clinical data obtained in vivo during 11 different hemodialysis sessions performed on 6 patients with a profiled sodium concentration in the dialysate and a profiled ultrafiltration rate. In all cases, the agreement between the time pattern of model solute concentrations in plasma and the in vivo data proves fairly good as to urea, sodium, chloride, potassium and bicarbonate kinetics. Only in two sessions was blood volume directly measured in the patient, and in both cases the agreement with model predictions was good. In conclusion, the model allows a priori computation of the amount of sodium removed during hemodialysis, and makes it possible to predict the plasma volume changes and plasma osmolarity changes induced by a given sodium concentration profile in the dialysate and by a given ultrafiltration profile. Hence, it can be used to improve clinical tolerance to the dialysis session taking the characteristics of individual patients into account, in order to minimize intradialytic hypotension.

show abstract

A Simple Mathematical Model of Intradialytic Sodium Kinetics: “in vivo” Validation During Hemodialysis with Constant or Variable Sodium

Cited by 20 publications

References 20 publications

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

Sodium and Fluid Modulation in Dialysis: New Approach

Evaluation of Intradialytic Solute and Fluid Kinetics

Contact Info

Product

Resources

About