Impact of Sodium and Ultrafiltration Profiling on Hemodialysis-Related Symptoms

Abstract

Abstract. Dialysate sodium and ultrafiltration profiling are two methods to reduce symptoms during hemodialysis. The objective of the study was to determine the efficacy of combining these techniques to reduce symptoms in chronic hemodialysis patients. Blood volume changes were measured to determine whether any benefit of profiling could be explained through this mechanism. Patients were randomized to profiled dialysate sodium and ultrafiltration or constant dialysate sodium and ultrafiltration. The study was a two-period, two-treatment, crossover design with repeated measures. The primary outcome was hypotension and/or symptomatic events observed by the dialysis nurse. Secondary outcomes were symptom survey scores, weights, BP, and blood volume changes. Thirty-three patients were randomized. On standard treatment, 30.6% of dialysis sessions were symptomatic compared with 20.4% on profiled treatments. The odds ratio for the development of hypotension or symptomatic event on profiled treatments was 0.61 (95% confidence interval, 0.39 to 0.96) compared with standard treatment. Patients had lower symptom scores by questionnaire in both the intradialytic and the interdialytic periods during profiled treatments. Predialysis weight was greater during profiled treatments by 0.3 kg (P = 0.008), but there were no differences in postdialysis weight, BP, or thirst. There was no difference in maximum decrease in blood volume during the two treatments (standard, -11.2%; profiled, -10.0%; P = 0.08), but there was a significant difference in the rate of change in blood volume (standard, -2.96%/h; profiled, -1.96%/h; P < 0.001). Decrease in blood volume, rate of change in blood volume, and predialysis weights were not associated with hypotension or symptomatic dialysis sessions. In conclusion, dialysate sodium and ultrafiltration profiling significantly reduces hemodialysis-related symptoms. Profiling reduces the slope of the blood volume curve during dialysis, but blood volume changes are not predictive of symptomatic events for an individual patient.

Individually adjusted absolute blood volume feedback control: A promising solution for intradialytic hypotension

“…[10][11][12] Consequently, most of studies initially performed were unable to show a relationship between RVB variations and the development of IDH. [13][14][15][16][17][18][19] From RBV to ABV As an attempt to solve RBV monitoring limitations in preventing IDH, Kron et al have recently developed a new method to measure ABV variations by analyzing RBV increase after online infusion of 240 mL ultrapure dialysate. 20,21 The authors identified a critical specific ABV threshold of 65 mL/kg as a predictor of volume-dependent IDH.…”

“…However, it tends to appear at a widely range of individual RBV levels as absolute blood volume (ABV) variations are not directly defined by same changes in RBV 10–12 . Consequently, most of studies initially performed were unable to show a relationship between RVB variations and the development of IDH 13–19 …”

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

“…The acute drop in plasma osmolarity further decreases fluid refill from the extravascular space, aggravating hemodynamic instability. Sodium profiling enhances the internal plasma refill rate and helps to stabilize the blood pressure, 7,8 thus decreasing the risk of IDH 9–11 . It is imperative to limit or prevent IDH since it does not only affect the patient's comfort but also increases the risk of vascular access thrombosis, 12 myocardial fibrosis and stunning, 13 cardiovascular events, and mortality 2,14–17 .…”

“…Sodium profiling enhances the internal plasma refill rate and helps to stabilize the blood pressure, 7,8 thus decreasing the risk of IDH. [9][10][11] It is imperative to limit or prevent IDH since it does not only affect the patient's comfort but also increases the risk of vascular access thrombosis, 12 myocardial fibrosis and stunning, 13 cardiovascular events, and mortality. 2,[14][15][16][17] However, interdialytic complications, particularly IDWG, fatigue and thirst have been reported with sodium profiling and the resulting sodium overload.…”

Patient perspectives of target weight management and ultrafiltration in haemodialysis: a multi-center survey

“…Prescription of fluid removal in haemodialysis involves a number of components. These include dialysis scheduling and interventions like profiling ultrafiltration rates or dialysate sodium concentrations [7,8], all of which aim to avoid hypovolemia. Arguably the most important aspect is the target weight.…”