Individualising / personalizing hemodialysate composition

Abstract

The effectiveness of the haemodialysis (HD) treatment directly affects the survival and quality of life of dialysis patients. In this regard, the composition of the dialysate, including the quality of the water, is very important. Normalizing the plasma electrolyte and mineral concentrations before to dialysis while reducing significant changes in the patient's intradialytic plasma concentrations is one of HD's main goals. For the purpose of avoiding intra- and interdialytic hypotension as well as pulmonary edoema, adequate sodium (Na) and water elimination is essential. The cardiovascular system and the bones may be protected by having the right amounts of calcium (Ca) and magnesium (Mg) in the dialysate. This will help to avoid extraskeletal calcifications, severe secondary hyperparathyroidism, and adynamic bone disease. A steady pH in body fluids is required for proper protein and membrane function as well as bone protection, and this is achieved by maintaining an adequate bicarbonate concentration [HCO3]. A sufficient dialysate glucose concentration prevents life-threatening hypoglycemia and severe hyperglycemia, which can cause serious cardiovascular problems and exacerbate diabetic comorbidities.