Of Sodium, Symptomatology and Syllogism

Abstract

Symptomatic intratreatment tolerance of patients to hemofiltration as found to be quantitatively superior to their tolerance to equivalent dialysis in both acute and chronic treatment series at matched sodium ion transport. These results refute an earlier speculative hypothesis that the better vascular stability during hemofiltration compared to hemodialysis is an artifact due to purportedly higher sodium transport during postdilution hemofiltration. In fact, corollary studies of catecholamine levels during matched hemofiltration and hemodialysis suggest that the improved tolerance to hemofiltration was a consequence of better maintained vasoconstrictive activity.

Sequential Hypertonic Dialysis

“…In addition, it is important to note that with SHD we were able to attain a greater fluid removal with no significant changes in neither plasma volume nor blood pressure, suggesting that the stability of plasma osmolality is the driving factor in the maintenance of vascular volume. Although we have used low sodium concentration during CH in the present study, the same trend of osmolar and plasma volume changes applies when this concentration is increased to 135-139 mEq/1 [28] . This sodium dialysate content was chosen attempt ing to document better the relation between osmotic shift and plasma volume changes.…”

Hemodialysis or Hemofiltration - the Patients’ View

“…In addition, different membranes such as poly amide or polyacrilonitrile are applied in H F. both of them revealing a better biocom patibility than cuprophane, at least when judged on the basis o f the activation o f the complement system [3]. Although it is evi dent when summarizing the reported data that chronic H F is not capable o f ameliorat ing any o f the typical uremic complications any better than H D , there is increasing evi dence that the incidence of symptomatic hy potension is less frequent with H F than with H D [4,5], It was recently suggested that it was not so much the different membranes applied for H D or H F which were o f major importance, than the flow o f the dialysate, which is absent in H F, as the dialysate has been shown to induce the production o f in terleukin I [4], Interleukin I designates the monocyte hormone which mediates not only fever and several aspects o f the acute phase response but is also capable o f producing hypotension and shock [6].…”