Sodium and ultrafiltration profiling in hemodialysis: A long‐forgotten issue revisited

Ertuğlu, Lale A.; Demiray, Atalay; Basile, Carlo; Afsar, Barış; Covic, Adrian; Kanbay, Mehmet

doi:10.1111/hdi.12952

Cited by 8 publications

(5 citation statements)

References 66 publications

(138 reference statements)

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“…In recent years, with the development of science and technology, some personalized biofeedback systems with real-time online monitoring equipment began to appear in the field of dialysis. Blood volume biofeedback, body temperature biofeedback, blood pressure biofeedback, sodium concentration biofeedback [26] are the most commonly used clinical applications. The biofeedback system of blood volume is suitable for volume management of patients with hypotension tendency and significant weight gain during dialysis.…”

Section: Biofeedback Systemmentioning

confidence: 99%

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

2023

MEDSC

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Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease. Intradialytic hypotension (IDH) is a serious complication during dialysis. It is mainly related to hypovolemia, resulting in premature interruption of dialysis, and insufficient clearance of fluid and solute, which eventually causes a variety of adverse clinical outcomes such as decline in quality of life, inadequate dialysis, vascular access embolism, loss of residual renal function, cardiovascular events and death, seriously threatening the life and health of patients. Despite its clinical significance, the early prediction of IDH remains a challenge. In recent years, the discovery of some new biomarkers and the use of volume assessment devices, hemodialysis equipment, biofeedback systems, new drugs and artificial intelligence early warning models have provided great help in the early identification and treatment of IDH. In view of the clinical heterogeneity of blood pressure changes in hemodialysis patients, it has become an inevitable trend to shift from standardized management to personalized nursing. This article mainly reviews the best strategies for personalized prevention and treatment of IDH.

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Section: Biofeedback Systemmentioning

confidence: 99%

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

2023

MEDSC

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“…Many publications have reported that dialysate sodium profiling improves tolerance to dialysis session. However, sodium profiling is most commonly associated with chronic overload due to increased average dialysate sodium, which is why its routine use to limit or prevent intradialytic hypotension is associated with increased weight gain 22 and higher all‐cause mortality 23 . Therefore, it has been claimed that “isonatric hemodialysis should be pursued, but sodium profiling, for the most part, avoided.” 24 …”

Section: Rationalementioning

confidence: 99%

Automated adjustment of dialysate sodium by the hemodialysis monitor: Rationale, implementation, and clinical benefits

Petitclerc

Mercadal

2022

Seminars in Dialysis

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Prescribing dialysate sodium is the responsibility of the physician, but there are currently no clear guidelines for this prescription. Furthermore, there is quite frequently a significant difference between prescribed and measured dialysate sodium. Several arguments, both theoretical and experimental, suggest that dialysate sodium should be adjusted individually in such a way as to result in a decreasing sodium profile that takes into account the patient's predialytic natremia. The generalization in clinical routine of this strategy requires the integration into the hemodialysis monitor of software making the machine capable to automatically adjust the dialysate sodium at each session. The only three such softwares that have been integrated into hemodialysis machines for routine clinical use are discussed. All three work with conductivity measurements as a surrogate for sodium concentrations. Although there are only a few publications on the use of these softwares in clinical practice, they appear to result in improved intradialytic tolerance to the dialysis treatment, better control of hypertension, and reduced thirst, leading to decreased interdialytic weight gain.

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“…Besides, it prevents more hypotension during HD by maintaining intravascular volume [ 19 ]. Recent studies have advocated the combination of the UF and sodium profiles to reduce numerous complications arising in HD [ 19 , 20 ]. For example, the linear UF-sodium profiling had improved BP in the HD patients in one study by Borzou et al (2015) [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study

Arasnezhad,

Namazinia,

Mazlum

et al. 2024

BMC Nephrol

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Background Considering no previous research into the utilization of ascending/descending ultrafiltration and linear sodium profiles in improving blood pressure among hemodialysis patients, the present study aimed to explore the effect of the A/D-UF along with linear sodium profiles on HD patients with hypotension. Methods Applying a crossover design, this clinical trial was fulfilled between December 2022 and June 2023 on 20 patients undergoing HD, randomized into two groups, each one receiving two intervention protocols, viz., (a) an intervention protocol in which the liquid sodium in the dialysis solution was linear and the UF profiling was A/D, and (b) a routine protocol or HD, wherein both liquid sodium and UF in the dialysis solution remained constant. The HD patients’ BP was then checked and recorded at six intervals, namely, before HD, one, two, three, and four hours after it, and following its completion, within each session. The data were further statistically analyzed using the IBM SPSS Statistics 20 and the related tests. Results In total, 20 patients, including 12 men (60%) and 8 women (40%), with the mean age of 58.00 ± 14.54 on HD for an average of 54 months, were recruited in this study. No statistically significant difference was observed in the mean systolic and diastolic BP levels in the group receiving the A/D-UF profile all through the desired hours (p > 0.05), indicating that the patients did not face many changes in these two numbers during HD. Our cross-over clinical trial demonstrated a statistically significant reduction in symptomatic IDH episodes from 55 to 15% with the application of the A/D-UF profile (p < 0.05). Conclusion The study demonstrated that the A/D-UF profile could contribute to the stability of blood pressure levels among HD patients, with no significant fluctuations observed during treatment sessions. Trial Registration This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20180429039463N5) on 07/01/2023.

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Sodium and ultrafiltration profiling in hemodialysis: A long‐forgotten issue revisited

Cited by 8 publications

References 66 publications

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

Automated adjustment of dialysate sodium by the hemodialysis monitor: Rationale, implementation, and clinical benefits

The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study

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