On-line monitoring and convective treatment modalities: short-term advantages

Locatelli, F

doi:10.1093/ndt/14.suppl_3.92

Cited by 8 publications

(5 citation statements)

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“…Both the pre- and post-dialysis plasma sodium concentrations did not vary significantly between HFR and HFR-Aeq; the amount of sodium removed during the two treatments was also similar, although numerically slightly higher during HFR-Aeq treatments. The sorbent cartridge, peculiarity of the HFR treatment, does not adsorb sodium, potassium, calcium, bicarbonate and urea [ 17 ].…”

Section: Resultsmentioning

confidence: 99%

“…They seem to be unable to both increase the peripheral vascular resistance and to vary the venous unstressed volume in case of hypotension [17–23]. …”

Section: Discussionmentioning

confidence: 99%

“…Most of the patients nowadays on a maintenance dialysis programme are characterized by left ventricular hypertrophy and other cardiovascular abnormalities; critical patients are prone to a higher degree of sensitivity towards the blood volume changes during the treatment. They seem to be unable to both increase the peripheral vascular resistance and to vary the venous unstressed volume in case of hypotension [ 17 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study

Locatelli

Stefoni

Petitclerc³

et al. 2012

Nephrology Dialysis Transplantation

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BackgroundIntradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH.MethodsFifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment. HFR-Aequilibrium (HFR-Aeq) is an evolution of the haemofiltration with endogenous reinfusion (HFR) dialysis therapy, with dialysate sodium concentration and ultrafiltration rate profiles elaborated by an automated procedure. The primary end point was the frequency of IDH.ResultsSymptomatic hypotension episodes were significantly lower on HFR-Aeq versus HFR (23 ± 3 versus 31 ± 4% of sessions, respectively, P l= l0.03), as was the per cent of clinical interventions (17 ± 3% of sessions with almost one intervention on HFR-Aeq versus 22 ± 2% on HFR, P <0.01). In a post-hoc analysis, the effect of HFR-Aeq was greater on more unstable patients (35 ± 3% of sessions with hypotension on HFR-Aeq versus 71 ± 3% on HFR, P <0.001). No clinical or biochemical signs of Na/water overload were registered during the treatment with HFR-Aeq.ConclusionsHFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na+ measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice.

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Section: Resultsmentioning

confidence: 99%

“…They seem to be unable to both increase the peripheral vascular resistance and to vary the venous unstressed volume in case of hypotension [17–23]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study

Locatelli

Stefoni

Petitclerc³

et al. 2012

Nephrology Dialysis Transplantation

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“…Not only is conductivity measurement noninvasive and inexpensive but also the linear correlation between the conductivity and sodium content has been used to estimate the sodium concentrate in the dialysate and patient's plasma. In fact, researchers also demonstrated a biofeedback system to automatically determine the water plasma and dialysate conductivity [15,23,24]. Conductivity measurement has resulted into the availability of on-line clearance monitors on various contemporary dialysis monitors (like Diascan ® Hospal-gambro; OCM; Fresenius).…”

Section: Conductivity Measurementsmentioning

confidence: 99%

On-line monitoring of electrolytes in hemodialysis: on the road towards individualizing treatment

Sharma

Wieringa²,

Frijns

et al. 2016

Expert Review of Medical Devices

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End-stage renal disease (ESRD) patients depend on dialysis for removal of toxic waste products, fluid overload relief and maintenance of electrolyte balance. Dialysis prolongs millions of lives. To some extent, ESRD has become a manageable disease with a steadily growing dialysis population of increasing average age and associated comorbidity. During 7 decades many technical refinements have been developed e.g. sodium profiling, blood volume, ultrafiltration variation based on blood pressure measurement, urea kinetics etc. Despite its large potentials, in-line electrolyte monitoring lags behind in dialysis treatment. Areas covered: In this paper, we review the state of technologies available for in-line monitoring of the electrolytes sodium, potassium and calcium during hemodialysis. Expert commentary: We concluded that individual optimization of dialysate composition should be able to improve hard medical outcomes, but practical clinical implementation stands/falls with reliable and affordable in-line ion-selective sensing technology. Optical ion-selective microsensors and microsystems form a promising pathway for individualizing the dialysis treatment.

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“…Conductivity measurements can be utilized as a surrogate of sodium concentration since there is a linear correlation between these parameters. Locatelli et al (21, 22) have recently described the use of a biofeedback system that allows for the automatic determination of plasma water and dialysate conductivity such that blood sampling can be avoided. With these measurements, along with session time, desired weight loss, and expected end‐treatment plasma water conductivity, the dialysate conductivity is automatically adjusted in order to achieve the prescribed final plasma water conductivity.…”

Section: Dialysate Sodiummentioning

confidence: 99%

Individualizing the Dialysate in the Hemodialysis Patient

Palmer

2001

Seminars in Dialysis

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In most outpatient centers the dialysate is prepared centrally such that the composition of the dialysate is the same for all patients. When delivered in this manner most patients tolerate the procedure well. However, there are patients who tolerate the procedure poorly, which has prompted a great deal of research focused on individualizing the composition of the dialysate in order to improve patient tolerability. Prescribing a patient-specific dialysate will become increasingly important as the age of and number of comorbid conditions increase in the dialysis population. Patients with end-stage renal disease (ESRD) depend on dialysis to maintain fluid and electrolyte balance. Hemodialysis allows for solutes to diffuse between blood and dialysate such that, over the course of the procedure, plasma composition is restored toward normal values. The makeup of the dialysate is of paramount importance in accomplishing this goal. In most out-patient settings patients receive hemodialysis using dialysate prepared in bulk and delivered via a central delivery system so that the composition of the dialysate is the same for all patients. While most patients tolerate the procedure when administered in this fashion, many patients suffer from hemodynamic instability or symptoms of dialysis disequilibrium. One strategy to improve the clinical tolerance to dialysis is to adjust the dialysate composition according to the individual characteristics of the patient. This article reviews recent developments on how the dialysate can be manipulated in order to improve patient tolerance. Individualizing the dialysate composition is likely to gain increasing importance given the advancing age and increasing number of comorbid conditions found in ESRD patients.

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On-line monitoring and convective treatment modalities: short-term advantages

Cited by 8 publications

References 0 publications

Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study

Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study

On-line monitoring of electrolytes in hemodialysis: on the road towards individualizing treatment

Individualizing the Dialysate in the Hemodialysis Patient

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