Is there any role for sodium modeling in the prevention of intradialytic hypotension in patients with large interdialytic fluid gains?

Stewart, Ian J.; Henrich, William L.

doi:10.1111/j.1525-139x.2011.00909.x

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…We conclude that quantifying Na + tissue removal could improve strategies for managing HD patients. 44 Cardiovascular mortality is markedly elevated in HD patients. However, whether or not tissue Na + excess contributes to cardiovascular morbidity or mortality is unclear.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance–determined sodium removal from tissue stores in hemodialysis patients

Dahlmann

Dörfelt

Eicher

et al. 2015

Kidney International

192

218

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We have previously reported sodium is stored in skin and muscle. The amounts stored in hemodialysis (HD) patients are unknown. We determined whether 23Na magnetic resonance imaging (sodium-MRI) allows assessment of tissue sodium and its removal in 24 HD patients, and 27 age-matched healthy controls. We also studied 20 HD patients before and shortly after HD with a batch dialysis system with direct measurement of sodium in dialysate and ultrafiltrate. Age was associated with higher tissue sodium content in controls. This increase was paralleled by an age-dependent decrease of circulating levels of vascular endothelial growth factor-C (VEGF-C). Older (over 60 years) HD patients showed increased sodium and water in skin and muscle, and lower VEGF-C levels than age-matched controls. After HD, patients with low VEGF-C levels had significantly higher skin sodium content than patients with high VEGF-C levels (low VEGF-C: 2.3 ng/ml and skin sodium: 24.3 mmol/L; high VEGF-C: 4.1ng/ml and skin sodium: 18.2mmol/L). Thus, sodium-MRI quantitatively detects sodium stored in skin and muscle in humans and allows studying sodium storage reduction in ESRD patients. Age and VEGF-C-related local tissue-specific clearance mechanisms may determine the efficacy of tissue sodium removal with HD. Prospective trials on the relationship between tissue sodium content and hard endpoints could provide new insights into sodium homeostasis, and clarify whether increased sodium storage is a cardiovascular risk factor.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance–determined sodium removal from tissue stores in hemodialysis patients

Dahlmann

Dörfelt

Eicher

et al. 2015

Kidney International

192

218

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Avoiding Harm and Achieving Optimal Dialysis Outcomes—The Dialysate Component

Spiegel¹

2012

Advances in Chronic Kidney Disease

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Hemodialysis: Core Curriculum 2014

Golper

Fissell

et al. 2014

American Journal of Kidney Diseases

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Kidney dialysis evolves as we learn more about the uremic condition. At its earliest versions the major transport process was diffusion, the spontaneous movement of particles down a concentration gradient, stimulated by thermal agitation, and affected by the collision of the particles with each other and with barriers such as dialysis membrane pore side walls. As dialysis was utilized to replace kidney function ultrafiltration (UF) was required, which could be generated by osmotic, oncotic, or hydrostatic pressures. Consequently, solvent drag effects of the UF led to an appreciation of the importance of convective transport and its advantageous property of increasing the removal of larger molecular sized (molecular weight + steric hindrance effects) species. Thus, modern dialysis generally utilizes both diffusive and convective transport and current devices and equipment allow for either process to occur independently or in combination. However, during convection solute is removed but concentrations in the retentate may not decrease unless substitution fluid is administered, a process called hemofiltration. Diffusion can occur without any UF. Appreciation of these extremes is important to the understanding of modern dialysis. Currently, dialysis cannot replace the endocrine or metabolic functions of the kidney so our discussion will be restricted to solute and fluid removal.

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Is there any role for sodium modeling in the prevention of intradialytic hypotension in patients with large interdialytic fluid gains?

Cited by 3 publications

References 21 publications

Magnetic resonance–determined sodium removal from tissue stores in hemodialysis patients

Magnetic resonance–determined sodium removal from tissue stores in hemodialysis patients

Avoiding Harm and Achieving Optimal Dialysis Outcomes—The Dialysate Component

Hemodialysis: Core Curriculum 2014

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