Automated adjustment of dialysate sodium by the hemodialysis monitor: Rationale, implementation, and clinical benefits

Abstract

Prescribing dialysate sodium is the responsibility of the physician, but there are currently no clear guidelines for this prescription. Furthermore, there is quite frequently a significant difference between prescribed and measured dialysate sodium. Several arguments, both theoretical and experimental, suggest that dialysate sodium should be adjusted individually in such a way as to result in a decreasing sodium profile that takes into account the patient's predialytic natremia. The generalization in clinical routine of this strategy requires the integration into the hemodialysis monitor of software making the machine capable to automatically adjust the dialysate sodium at each session. The only three such softwares that have been integrated into hemodialysis machines for routine clinical use are discussed. All three work with conductivity measurements as a surrogate for sodium concentrations. Although there are only a few publications on the use of these softwares in clinical practice, they appear to result in improved intradialytic tolerance to the dialysis treatment, better control of hypertension, and reduced thirst, leading to decreased interdialytic weight gain.

Personalized Management of Sodium and Volume Imbalance in Hemodialysis to Mitigate High Costs of Hospitalization

“…An automated and active dialysate sodium concentration adjustment to patient's plasma sodium concentration while assessing sodium mass removal has been advocated by experts [109]. The tight linear relationship between sodium content and conductivity of saline solutions enables the continuous estimation of sodium levels (compensated for potassium changes) during each HD session [96,[110][111][112]. Conductivity kinetic modeling tools that facilitate the control of diffusive sodium transfer during therapy have been advanced in recent years by using modern sensors and analytics and allow for inexpensive, accurate, and individualized sodium balance and prescriptions [28,84,90,103,[110][111][112][113].…”

“…The tight linear relationship between sodium content and conductivity of saline solutions enables the continuous estimation of sodium levels (compensated for potassium changes) during each HD session [96,[110][111][112]. Conductivity kinetic modeling tools that facilitate the control of diffusive sodium transfer during therapy have been advanced in recent years by using modern sensors and analytics and allow for inexpensive, accurate, and individualized sodium balance and prescriptions [28,84,90,103,[110][111][112][113]. In this setting, sodium mass removal and free water may be managed almost independently by the sodium module following physician prescription and patient's profile.…”