Sodium modeling

Mann, H.; Stiller, S.

doi:10.1016/s0085-2538(15)47404-6

Cited by 28 publications

(38 citation statements)

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“…The different mass transfer coefficients yield the following times for equilibrium to take place between the extracellular space (ECV) and the ICV: 30 s for osmotic equilibrium (because of the high cell wall permeability to water), 20 min for urea equilibrium and over 10 h for equilibrium of the ICV-ECV sodium concentrations. A mathematical model devised by Mann and Stiller [12] calculates the volume shift as a function of eliminated quantities of solutes; in particular, it considers sodium to be the very effective osmole: if the extracellular sodium is decreased by 5 mmol/L and osmotic equilibrium is established, the ECV decreases by 6%. These events cause intradialytic hypotension that involves 20-50% of HD sessions and can significantly increase the risk of death in the short and long term [13].…”

Section: Dialysate Sodium and Hypotensionmentioning

confidence: 99%

Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Donati¹,

Ursino²,

Spazzoli³

et al. 2017

Blood Purif

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Background: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist, as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium levels. Methods: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller. Results: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis (HD) and discusses 2 strategies to remove excess sodium in patients prone to intradialytic hypotension, namely, Profiled HD and the hemodiafiltration Aequilibrium System. Conclusion: The Profiled HD and Aequilibrium System trial both proved effective in counteracting intradialytic hypotension.

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Section: Dialysate Sodium and Hypotensionmentioning

confidence: 99%

Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Donati¹,

Ursino²,

Spazzoli³

et al. 2017

Blood Purif

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“…The latter is to avoid excessive sodium gain that comes from high-sodium dialysis and is another essential part of the sodium profiling haemodialysis. 1 A wide variety of profiling patterns are available. It can be done with curve types of decreasing, increasing, or alternating.…”

Section: Sodium Profilingmentioning

confidence: 99%

“…2 Thus, a zero sodium balance can be achieved by lowering the dialysate sodium activity from 3 to 7 mEq/L below the plasma sodium activity. 1,2,14 However, this is only true with the actual sodium activity. The serum sodium concentration measured by the flame photometry is apt to the dilutional error in representing electrochemical activity.…”

Section: Sodium Transport Across Dialysermentioning

confidence: 99%

“…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][3][4][5][6][7][8][9][10] Many authors have tried to find an optimal sodium concentration in the dialysis fluid to minimize the intradialytic sodium gain.…”

Section: Introductionmentioning

confidence: 99%

“…During the conventional haemodialysis, optimal sodium is estimated close or equal to the plasma sodium concentration. 1,[11][12][13][14] However, the efforts have been rare for the sodium profiling haemodialysis: not even a parameter representative of the sodium activity in dialysis fluid during the sodium profiling haemodialysis has yet been investigated. We have recently reported that the time-averaged concentration of dialysate sodium during the session of sodium profile represents the sodium activity in dialysis and directly relates to the diffusive sodium balance.…”

Section: Introductionmentioning

confidence: 99%

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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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Effect of dialysate sodium profiling and gradient ultrafiltration on hypotension

Cosar¹,

Çınar²

2009

Dialysis & Transplantation

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Hypotension is a common side effect of hemodialysis. 1 Intradialytic hypotension is a common adverse event that occurs in 20% to 50% of all dialysis treatments. 2,3 Dialysis hypotension usually presents in 1 of the 2 ways: as episodic hypotension (symptomatic hypotension), in which a sharp fall in blood pressure (usually late in dialysis) accompanied by signs and symptoms of hypotension are noted, and chronic persistent hypotension, in which systolic blood pressure is less than 90 to 100 mmHg at the onset of dialysis. Chronic persistent hypotension is estimated to occur in 3% to 5% of the dialysis population, whereas episodic hypotension occurs in between 15% and 25% of all dialysis encounters. 4 Chronic persistent hypotension is characterized by high circulating angiotensin II levels and maximal pre-dialysis vasoconstriction. 4,5 Symptomatic hypotension has multiple etiologies. Several studies have shown that a fall in plasma osmolality as ultrafi ltration proceeds compounds extracellular volume depletion because fl uid moves intracellularly. 6,7,8 This has led to the routine use of a higher sodium dialysate concentration with reported favorable outcomes. 9,10 Both of these conditions are therapeutic challenges because ultrafi ltration requirements are diffi cult to achieve in the context of hemodynamic instability. Patients who are frequently hypotensive often feel unwell and spend the interdialytic period "recovering" from the preceding dialysis. 11 Symptomatic hypotension can occur when the so-called dry weight of the patient is not attained. Dry weight cannot be determined exactly in hemodialysis. In practice, the choice of dry weight is most often based solely on clinical criteria. 12 Dialysis hypotension has a multifactorial etiology, including such disparate causes as autonomic dysfunction, 13 decreased plasma osmolality, 6,14,15 a decrease in extracellular fl uid volume with inadequate plasma, 5 decreased cardiac reserve, 16,17 impaired venous compliance, 18 and high plasma nitric oxide levels. 19 If there are no other reasons such as cardiac dysfunction or insuffi ciency of the autonomic nervous system, it is induced when ultrafi ltration exceeds refi lling of the intravascular compartment. 16,20 Intradialytic hypotension associated with declining plasma osmolality due to diffusion contributes to complications that decrease patient's well-being during dialysis. 21,22 Many strategies have been devised to decrease osmolality change through intravenous mannitol, 7 gradient/ramping sodium dialysate, 15,21,23-25 ultrafi ltration profi ling, 26,27 and used with gradient sodium and gradient ultrafi ltration. 7,9,22,28,29 It has been shown that limiting the reduction in plasma osmolality during hemodialysis by selecting a higher sodium concentration of the dialysate improves OBJECTIVE: This study aimed to investigate the effects of dialysate sodium profi ling and gradient ultrafi ltration on hypotension during hemodialysis.METHODS: In this study, a single-blinded, crossover design of 4 different dialysis proto...

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Sodium modeling

Cited by 28 publications

References 0 publications

Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Optimization of dialysate sodium in sodium profiling haemodialysis

Effect of dialysate sodium profiling and gradient ultrafiltration on hypotension

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