Sodium ramping in hemodialysis: A study of beneficial and adverse effects

Sang, George Lam Sui; Kovithavongs, Carl; Ulan, Raymond A.; Kjellstrand, Carl M.

doi:10.1016/s0272-6386(97)90118-9

Cited by 108 publications

(84 citation statements)

References 15 publications

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“…Seven of 10 patients reported a "cold" sensation and two patients were noted to be shivering on dialysis. A similar study by Rezki et al [22] evaluated 16 patients in a two-phase protocol. The first phase consisted of three standard HD sessions with a sodium concentration of 140 mEq/L with dialysate temperature at 37 ℃ and served as the control for each patient.…”

Section: Effect Of Cooled Dialysate On Vulnerable Vascular Bedsmentioning

confidence: 99%

“…Each patient underwent four protocols commonly employed to minimize IDH in addition to a standard dialysis protocol which served as a control. The protocols were as follows: A standard dialysis group with dialysate sodium of 138 mEq/L (served as the control group), high sodium dialysate (patient dialyzed using a steady dialysate sodium of 144 mEq/L), sodium modeling using a step function design (dialysate sodium declined from 152 to 140 mEq/L in the last 30 min of interdialytic weight gain due to increased thirst [23] . Whether one method is superior at reducing IDH or is better tolerated than the other remains to be seen in a larger trial with longer follow-up periods.…”

Section: Cooled Dialysate Compared To Other Modalities Used To Minimimentioning

confidence: 99%

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Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Toth‐Manikowski

Sozio

2016

WJN

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The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension (IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst incenter hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 ℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here. Core tip: Cooled dialysate is commonly employed to reduce the incidence of intradialytic hypotension (IDH) in patients on chronic dialysis. The studies to date that have evaluated cooled dialysate are limited by small sample size and it has not become the standard of care for managing IDH. However, the small studies that exist are promising and suggest that cooling dialysate improves hemodynamic tolerability of dialysis, minimizes IDH, and exerts a protective effect over major organs including the heart and brain. More studies are needed to assess the long-term effects of cooling dialysate in this population.Toth-Manikowski SM, Sozio SM. Cooling dialysate during incenter hemodialysis: Beneficial and deleterious effects. World J Nephrol 2016; 5(2): 166-171 Available from:

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Section: Effect Of Cooled Dialysate On Vulnerable Vascular Bedsmentioning

confidence: 99%

Section: Cooled Dialysate Compared To Other Modalities Used To Minimimentioning

confidence: 99%

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Toth‐Manikowski

Sozio

2016

WJN

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“…Sodium ramping that is prescribed to offset intradialytic hemodynamic instability is associated with fewer hypotensive episodes on dialysis but greater interdialytic fatigue and thirst, greater interdialytic weight gain, and hypertension. 94 Interdialytic 24-hour ambulatory BP increased when the time-averaged concentration of sodium was extremely elevated at 147 mEq/dl. 95 Therefore, one sodium prescription may not fit all patients.…”

Section: Dietary Sodium Restrictionmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

157

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…In a slow-flow shortened dialysis, it may be useful to limit the time to 2 hours and the blood flow rate to 200 ml/min and to use a dialyzer with a small surface area (Levin&Goldstein,1996;Sang et al,1997). The target rate of urea reduction may be 0.4 to 0.45 for the first session.…”

Section: Disequilibrium Syndromementioning

confidence: 99%