Sequential Hypertonic Dialysis

Martín‐Malo, Alejandro; Perez, Robert; Gomez, J. I. Esquivias; Burdiel, L G; Enrique, Andrés; Castillo, Domingo del; Moreno, Ernestina Pinal; Aljama, Pedro

doi:10.1159/000183520

Cited by 12 publications

(4 citation statements)

References 9 publications

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“…To minimize the effect of blood volume reduction as one of the contributing factors, it is extremely important to carefully observe the distribution of fluids and sodium [3, 4, 5, 6, 7, 8, 9]. The sodium dialysate concentration has often been increased so as to obtain intradialytic cardiovascular stability [10].…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

Sodium and Fluid Modulation in Dialysis: New Approach

Splendiani

Costanzi²,

Passalacqua³

et al. 2001

Nephron

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“…For these purposes, the sodium in the dialysis fluid follows a time‐dependent profile over the course of the session, including high‐sodium dialysis periods to maintain the patient's intravascular blood volume and low‐sodium dialysis periods to compensate for the excessive sodium gain 1 . In spite of this low‐sodium dialysis period, many reports indicate that the sodium profiling haemodialysis shows shortcomings of the chronic sodium load, which presents as elevated postdialysis serum sodium concentration and as thirst, excessive weight gain, or hypertension during interdialytic period 2–10 …”

Section: Introductionmentioning

confidence: 99%

Optimization of dialysate sodium in sodium profiling haemodialysis

et al. 2003

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Sodium profiling haemodialysis is a modified method of sodium gradient dialysis during which dialysate sodium follows a time-dependent profile. Sodium profiling haemodialysis has claimed to reduce intradialytic discomforts such as hypotension, muscle cramps, and disequilibrium syndrome. Having the low sodium period is an essential part of the sodium profiling haemodialysis to compensate for the sodium gain during the high sodium period. In spite of this, however, the incidence of interdialytic complications that results from the excessive sodium gain has been reported in previous literature. Making the prediction of optimal dialysate sodium concentration for isonatric dialysis is practically very difficult since too many variables influence the sodium gradient, including the initial plasma sodium and tonicity and/or dialysis dynamics that differ from patient to patient and from treatment to treatment. As for sodium profiling haemodialysis, complexities are added further since details of profile, such as type and form of profile, or initial, terminal, or time-distribution of dialysate sodium are varied considerably. We have recently reported that the intradialytic sodium balance and interdialytic weight gain are directly related to the time-averaged concentration of dialysate sodium (TACNa). The dialysate sodium can be optimized using this concept of TACNa for sodium profiling dialysis. TACNa should be approximately 0.5-0.8 mmol/L lower than patient's predialysis serum sodium concentrations to achieve a sodium balance neutral dialysis. In that study the optimal TACNa, seems to be between 137.8 and 143.5 mmol/L. Such an optimal value should be defined for the individual centres based on their profile protocols for clinical use. In the future, dialysate sodium should be optimized based on the exact prediction of the postdialysis plasma sodium levels.

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“…This can be adjusted manually or automatically using computer controlled profiles available on many dialysis delivery systems. Studies of sodium profiling generally have shown a reduction in intradialytic symptoms but at the expense of increased symptoms between dialysis treatments (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

mentioning

confidence: 99%

Impact of Sodium and Ultrafiltration Profiling on Hemodialysis-Related Symptoms

Oliver¹,

Edwards²,

Churchill³

2001

Journal of the American Society of Nephrology

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Abstract. Dialysate sodium and ultrafiltration profiling are two methods to reduce symptoms during hemodialysis. The objective of the study was to determine the efficacy of combining these techniques to reduce symptoms in chronic hemodialysis patients. Blood volume changes were measured to determine whether any benefit of profiling could be explained through this mechanism. Patients were randomized to profiled dialysate sodium and ultrafiltration or constant dialysate sodium and ultrafiltration. The study was a two-period, two-treatment, crossover design with repeated measures. The primary outcome was hypotension and/or symptomatic events observed by the dialysis nurse. Secondary outcomes were symptom survey scores, weights, BP, and blood volume changes. Thirty-three patients were randomized. On standard treatment, 30.6% of dialysis sessions were symptomatic compared with 20.4% on profiled treatments. The odds ratio for the development of hypotension or symptomatic event on profiled treatments was 0.61 (95% confidence interval, 0.39 to 0.96) compared with standard treatment. Patients had lower symptom scores by questionnaire in both the intradialytic and the interdialytic periods during profiled treatments. Predialysis weight was greater during profiled treatments by 0.3 kg (P = 0.008), but there were no differences in postdialysis weight, BP, or thirst. There was no difference in maximum decrease in blood volume during the two treatments (standard, -11.2%; profiled, -10.0%; P = 0.08), but there was a significant difference in the rate of change in blood volume (standard, -2.96%/h; profiled, -1.96%/h; P < 0.001). Decrease in blood volume, rate of change in blood volume, and predialysis weights were not associated with hypotension or symptomatic dialysis sessions. In conclusion, dialysate sodium and ultrafiltration profiling significantly reduces hemodialysis-related symptoms. Profiling reduces the slope of the blood volume curve during dialysis, but blood volume changes are not predictive of symptomatic events for an individual patient.

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Sequential Hypertonic Dialysis

Cited by 12 publications

References 9 publications

Sodium and Fluid Modulation in Dialysis: New Approach

Sodium and Fluid Modulation in Dialysis: New Approach

Optimization of dialysate sodium in sodium profiling haemodialysis

Impact of Sodium and Ultrafiltration Profiling on Hemodialysis-Related Symptoms

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