Sodium modeling

Mann, H.; Stiller, S.

doi:10.1046/j.1523-1755.2000.07610.x

Cited by 28 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is in agreement with the known increase in plasma sodium concentration after an injection of 2 g of hypertonic sodium chloride, containing 0.8 g of sodium, which has been estimated to be 1.1 mmol/L (14).…”

Section: Discussionsupporting

confidence: 90%

Measuring Plasma Conductivity to Detect Sodium Load in Hemodialysis Patients

Mercadal¹,

Venditto²,

Renault³

et al. 2008

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background: Sodium thiosulfate therapy has been proposed for calcific uremic arteriolopathy and nephrogenic systemic fibrosis in hemodialysis patients. The treatment brings 3.7 g (161 mmol) of sodium. How to counterbalance this sodium load was studied.Design, setting, participants, & measurements: Plasma conductivity (Cp) and mass balance index were compared for 20 sessions without thiosulfate and 20 sessions with thiosulfate infusion. Subsequently, the dialysate conductivity was set to 13.8 mS/cm during the entire session. Next, dialysate conductivity was set to 14 mS/cm for the first 3 h and to 13 mS/cm for the last hour of thiosulfate infusion (n ‫؍‬ 25).Results: The Cp variation between beginning and end was equal to ؉0.005 ؎ 0.13 mS/cm without thiosulfate, ؉0.24 ؎ 0.13 mS/cm with thiosulfate, and 14 mS/cm dialysate conductivity (P < 0.001). The decrease in dialysate conductivity at 13.8 mS/cm did not counterbalance the sodium load. The last program adequately compensated the sodium load with a Cp increase of only ؉0.05 ؎ 0.14 mS/cm (NS versus without thiosulfate). The total of the dialyzed sodium and the sodium load for this last program was equal to 603 mmol compared with 456 mmol for the sessions without thiosulfate, the difference of 147 mmol being close to the known content of 161 mmol in 25 g of infused thiosulfate.Conclusions: Thiosulfate infusion requires a decrease of dialysate conductivity of ؊1 mS/cm during the infusion to counterbalance the added 3.7 g (161 mmol) sodium load.

show abstract

Section: Discussionsupporting

confidence: 90%

Measuring Plasma Conductivity to Detect Sodium Load in Hemodialysis Patients

Mercadal¹,

Venditto²,

Renault³

et al. 2008

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…expectation, however, such benefits have not been shown convincingly (6,7,16). Some early studies reported that sodium profile with average dialysate sodium concentration of physiologic level obtained the hemodynamic benefits without sodium gain (19,20), but the benefits were too moderate to justify its use.…”

Section: Discussionmentioning

confidence: 99%

“…Sodium profiling hemodialysis is a dialysis maneuver developed to avoid IHD by the modulation of dialysate sodium concentration according to preestablished profiles (e.g., chang-ing dialysate sodium concentration, mostly from high to low, typically from initially supraphysiologic values) (6,7). It was designed to reserve the benefits from high-dialysate sodium and avoid unnecessary intradialytic sodium gain at the same time.…”

mentioning

confidence: 99%

Effect of Sodium Balance and the Combination of Ultrafiltration Profile during Sodium Profiling Hemodialysis on the Maintenance of the Quality of Dialysis and Sodium and Fluid Balances

Song¹,

Park²,

Lee³

et al. 2005

Journal of the American Society of Nephrology

118

View full text Add to dashboard Cite

Excessive sodium gain is a major hindrance of sodium profiling hemodialysis (HD) that offsets the benefit in reducing intradialytic hypotension-related discomforts (IHD). Patients who showed frequent IHD (>30% of the sessions; n ‫؍‬ 11) were enrolled in a prospective study that consisted of two phases. In the phase 1 study, eight treatment modalities were evaluated: Conventional HD (control), sodium balance-positive step-down sodium profiling HD (PS), sodium balance-neutral stepdown sodium profiling HD (NS), sodium balance-neutral alternating sodium profiling HD (NA) without ultrafiltration (UF) profile, and all those with UF profile (UF only, PS؉U, NS؉U, and NA؉U). The incidences of "dialysis failure," defined as the occurrence of one or more of (1) session failure (discontinuation of session <75% of planned time), (2) UF failure (%UF achieved <70%), and (3) delivery failure (Kt/V <1.1), were 48.5, 21.2, 42.4, 39.4, 45.5, 18.2, 21.2, and 18.2% in control, PS, NS, NA, UF only, PS؉U, NS؉U, and NA؉U, respectively. Four treatments, PS, PS؉U, NS؉U, and NA؉U, reduced the incidence of dialysis failure significantly as compared with control (P < 0.05) and were evaluated in the phase 2 study, a randomized controlled 6-wk crossover study. Parameters were measured in the steady state after a 6-wk maintenance of each treatment. Diffusive sodium gain (⌬Na) was significantly increased with sodium balance-positive profiles with or without UF profile, PS and PS؉U (PS 1.9 ؎ 1.1, PS؉U 1.7 ؎ 1.0 mEq/L; both P < 0.05 to control ؊0.1 ؎ 0.2, NS؉U 0.5 ؎ 0.4, NA؉U 0.4 ؎ 0.2 mEq/L). They also increased the interdialytic weight gain (PS 3.8 ؎ 0.6, PS؉U 4.0 ؎ 0.6 kg; both P < 0.05 to control 2.7 ؎ 0.6, NS؉U 3.3 ؎ 0.6 kg; both P ‫؍‬ NS to NA؉U 3.5 ؎ 0.6 kg). Predialysis weight and the required amount of UF also increased significantly with these sodium balance-positive profiles. Although the absolute amount of UF was larger with PS and PS؉U, %UF achieved targeting dry weight was higher with sodium balance-neutral profiles with UF profiles, NS؉U and NA؉U (NS؉U 92.7 ؎ 3.8, NA؉U 93.7 ؎ 6.8%; both P < 0.05 to control 72.6 ؎ 14.0, PS 88.3 ؎ 6.6, PS؉U 88.2 ؎ 8.2%). Postdialysis weight was closest to dry weight with these treatments showing ⌬ (postdialysis weight ؊ dry weight) of 0.3 ؎ 0.1 and 0.3 ؎ 0.2 kg in NS؉U and NA؉U (both P < 0.05 to control 1.0 ؎ 0.6 kg; both P ‫؍‬ NS to PS 0.5 ؎ 0.3, PS؉U 0.5 ؎ 0.4 kg). Incidence of excessive weight gain and subjective discomforts during the interdialytic period increased significantly with PS. In conclusion, continuous use of sodium balance-positive sodium profiles resulted in an undesirable steady state with sodium and fluid expansion offsetting their hemodynamic benefit. Sodium balance-neutral sodium profiles in combination with UF profile were associated with less sodium and weight gains, better UF performance with postdialysis weight closest to dry weight, and fewer interdialytic problems with the equivalent hemodynamic benefit. Therefore, it is proposed that sodium balance-neutral sodium profiling...

show abstract

“…Although sodium is mainly removed by ultrafiltration (about 6.9 g sodium chloride/liter ultrafiltrate [34] ), a positive sodium gradient may result in a net sodium load during treatment, depending on the ultrafiltration volume and the gradient. Regardless of the presence or absence of net sodium gain, a positive sodium gradient will in most cases result in an increase in postdialysis plasma sodium levels, resulting in thirst.…”

Section: Alignment Of Dialysate Sodium With Plasma Sodium Concentrationmentioning

confidence: 99%

“…This counteracts rapid changes in plasma osmolality due to uremic toxin removal and may limit decreases in blood volume. During the course of the treatment, the dialysate sodium concentration is lowered gradually or stepwise to avoid unnecessary sodium loading [34] . Although sodium profiling can indeed reduce the number of intradialytic hypotensive episodes on the short term, this is largely explained by the positive sodium balance of many of these profiles [40] .…”

Section: Avoidance Of Inappropriate Sodium Profilingmentioning

confidence: 99%

Improving Volume Status by Comprehensive Dietary and Dialytic Sodium Management in Chronic Hemodialysis Patients

2010

View full text Add to dashboard Cite

Chronic volume overload is highly prevalent in chronic hemodialysis patients and leads to hypertension, left ventricular hypertrophy and increased hospitalization and mortality rates. Volume overload is caused primarily by a positive sodium balance and can be improved by sodium restriction. The main sources of sodium excess are a high-sodium diet in the interdialytic period and a positive sodium balance during dialysis. Here we discuss different approaches to achieve neutral or negative sodium balance, including reducing dietary sodium intake, individualizing dialysate sodium prescription, abandonment of sodium profiling, and reducing saline infusion for treatment of intradialytic symptoms and as part of dialyzer rinsing and priming procedures. All of these approaches should be combined for a maximal reduction of volume overload.

show abstract

Sodium modeling

Cited by 28 publications

References 0 publications

Measuring Plasma Conductivity to Detect Sodium Load in Hemodialysis Patients

Measuring Plasma Conductivity to Detect Sodium Load in Hemodialysis Patients

Effect of Sodium Balance and the Combination of Ultrafiltration Profile during Sodium Profiling Hemodialysis on the Maintenance of the Quality of Dialysis and Sodium and Fluid Balances

Improving Volume Status by Comprehensive Dietary and Dialytic Sodium Management in Chronic Hemodialysis Patients

Contact Info

Product

Resources

About