Profiling Dialysis: A New Approach to Dialysis Intolerance

Bonomini, V.; Colì, L.; Scolari, Maria

doi:10.1159/000189491

Cited by 12 publications

(9 citation statements)

References 7 publications

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“…Bonomini et al [15]observed that ‘profiled dialysis‘ discussed 10 years ago is a matter of renewed interest. We were among the first authors who used this method [7].…”

Section: Discussionmentioning

confidence: 99%

Sodium and Fluid Modulation in Dialysis: New Approach

Splendiani

Costanzi²,

Passalacqua³

et al. 2001

Nephron

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Hypotension during hemodialysis is still an unsolved problem. The treatment of patients with cardiovascular instability is efficaciously carried out with the use of ‘profiled dialysis’ (PD) with computerized modulation of ultrafiltration and conductivity. We tested a new profile model which involves progressive decrease of ultrafiltration associated with variable conductivity (‘bell pattern’). We observed 8 stable long-term patients receiving hemodialysis (4 men and 4 women, mean age 63.5 years) for 4 h three times a week. Before our test, sodium balance had reached a steady state in all patients and remained stable during the entire observation period. The sodium balance was established by means of a simple pattern suggested by Ursino and coworkers. The patients were observed for two periods of 1 month each (protocols A and B). The intradialytic mean arterial pressure was studied, checking every hour of dialysis. Statistical analysis was done by ANOVA for repeated measures. We compared standard dialysis with constant ultrafiltration rate and conductivity (protocol A) with sessions performed involving a progressive decrease of ultrafiltration together with a variable conductivity of –0.2, +0.2, +0.6, +0.6, 0, –0.4, –0.4, and –0.4 mS/s (protocol B). We found a lower incidence of hypotension (p < 0.01) with better cardiovascular stability during and after treatment in ‘profiled dialysis’.

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“…Bonomini et al [15]observed that ‘profiled dialysis‘ discussed 10 years ago is a matter of renewed interest. We were among the first authors who used this method [7].…”

Section: Discussionmentioning

confidence: 99%

Sodium and Fluid Modulation in Dialysis: New Approach

Splendiani

Costanzi²,

Passalacqua³

et al. 2001

Nephron

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“…In addition to this, dialysis fluid sodium concentrations can be selected not only to prevent intracellular water uptake but also to support water transport into the extracellular space, that is, to support plasma refilling (9–14). However, the effect of sodium profiling on preserving EC volume is small compared to the volume depletion caused by ultrafiltration (11,15).…”

Section: Sodium Profilingmentioning

confidence: 99%

“…Existing systems for monitoring sodium removal during treatment (50), computerized sodium balancing and modeling (10,28,30,42,46,51,52), and biofeedback technology must be integrated into more and precise studies.…”

Section: Sodium Profilingmentioning

confidence: 99%

A Critical Review of Sodium Profiling for Hemodialysis

Stiller

Bonnie-Schorn²,

Grassmann³

et al. 2001

Seminars in Dialysis

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In sodium profiling, the sodium concentration in the dialysis fluid, instead of being constant, follows a time-dependent profile over the course of a hemodialysis session. The main aim of this manipulation is to avoid osmotic disequilibrium by keeping plasma osmolality in the physiological range. Further advantages of sodium profiling are a reduction in the incidence of muscle cramps, improved sodium removal, and improved vascular stability. Many different profiles have been used by various investigators. However, if sodium profiling is not appropriately conducted, sodium accumulation with resulting augmented thirst, increase of interdialytic weight gain, and hypertension may result. Sodium accumulation may, in fact, explain the reduced intradialytic morbidity reported in some short-term sodium profiling studies. Randomized, double-blind studies meeting strict statistical criteria and providing a careful control to maintain equivalent sodium balances between the compared treatments are difficult to perform and have not yet been published. However, because sodium profiling has potential benefits, provided that sodium balance is carefully controlled, it should nevertheless be regarded as a tool that experienced nephrologists can use for the treatment of patients who experience intolerable side effects during standard dialysis.

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“…Because PHD may represent an interesting approach in view of the potential it holds for coping with some forms of clinical dialysis intolerance ( 20), we continued to study the clinical application of this technique. The preestablished modulation of sodium removal represents the basic mechanism through which PHD operates.…”

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confidence: 99%

Clinical Use of Profiled Hemodialysis

et al. 1998

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The new population on dialysis today consists mainly of high risk patients (the elderly, diabetics, etc.) with high cardiovascular scores, and such vascular pathology is the most important predisposing factor for the occurrence of a frequent intradialytic clinical complication, vascular instability syndrome, which covers a range of clinical problems. Recently a new dialysis technique, profiled hemodialysis (PHD), has been set up and proposed for routine use. PHD consists of the clinical use of preestablished individual dialysis profiles aimed at antagonizing the changes in intradialytic plasma osmolarity by continuous modulation of dialysate sodium concentration throughout the whole extracorporeal session. In particular, PHD aims at reducing the fall of plasma osmolarity in the first half of the session (when it is higher) by reducing the sodium removal rate through increasing its dialysate concentration while taking into account the desired individual sodium balance to be reached at the end of the session. In this work, we report clinical experience with PHD compared to standard hemodialysis with constant sodium dialysate (SHD) in terms of its efficacy to maintain a more stable intradialytic blood volume (BV) and more stable hemodynamics. The PHD used in this work has been implemented by a mathematical model for computing the individual dialysate sodium profile which we have recently validated (Ursino M, Coli L, La Manna G, Grilli Cicilioni M, Dalmastri V, Guidicissi A, Masotti P, Avanzolini G, Stefani S, Bonomini V. A simple mathematical model of intradialytic sodium kinetics: "in vivo" validation during hemodialysis with constant or variable sodium. Int J Artif Organs 1996;19:393-403.). Eleven uremic patients affected by hypotension at the beginning of dialysis treatment were studied. Each patient first underwent an SHD treatment and 1 week later a PHD treatment. The 2 extracorporeal sessions (one on SHD and the other on PHD) were performed in each individual patient under identical operative conditions including the sodium mass removal by the end of the session and the ultrafiltration rate. The crit line and Doppler echocardiography were used to determine BV, cardiac output (CO), and stroke volume (SV) throughout the sessions. The mean blood pressure (MBP) and heart rate (HR) were simultaneously monitored. PHD was associated with a more stable intradialytic BV and more stable hemodynamics compared to SHD. The higher stability of BV and cardiac function (in terms of SV and CO maintenance) which was obtained above all in the first half of the PHD session was associated with a higher stability of the MBP and the HR. This resulted in an enhancement in cardiovascular tolerance to ultrafiltration throughout the session in all tested patients. In contrast, SHD in the same patients was characterized by early significant changes in BV and cardiovascular parameters resulting in a significant decrease of the MBP and a significant increase of the HR throughout the session and also 1 h after the end of dialysis. Our resul...

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Profiling Dialysis: A New Approach to Dialysis Intolerance

Cited by 12 publications

References 7 publications

Sodium and Fluid Modulation in Dialysis: New Approach

Sodium and Fluid Modulation in Dialysis: New Approach

A Critical Review of Sodium Profiling for Hemodialysis

Clinical Use of Profiled Hemodialysis

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