Sodium setpoint and gradient in bicarbonate hemodialysis

Basile, Carlo; Libutti, Pasquale; Lisi, Piero; Vernaglione, Luigi; Casucci, Francesco; Losurdo, Nicola; Teutonico, Annalisa; Lomonte, Carlo

doi:10.5301/jn.5000236

Cited by 30 publications

(29 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study confirmed the results of earlier studies which indicated that HD patients have stable pre-HD serum sodium levels even after manipulation of dialysate sodium (de Paula et al 2004;Basile et al 2012). Although some long-term studies have revealed that individual osmolar set-points are influenced by changes in dialysate sodium concentration, they vary by less than 1% (Song et al 2002;Thein et al 2007).…”

Section: Discussionsupporting

confidence: 91%

“…In current clinical practice, most hemodialysis (HD) centers adopt a standard dialysate sodium prescription in the range of 136-142 mmol/L, with only a few variations according to patients' clinical conditions. It has been documented that patients on chronic HD have relatively constant pre-HD serum sodium levels, but vary considerably from patient to patient (Peixoto et al 2010;Basile et al 2012). Therefore, a single dialysate sodium prescription for all HD patients may adversely affect sodium balance in a significant proportion of patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Increasing the Dialysate Sodium Concentration Based on Serum Sodium Concentrations Exacerbates Weight Gain and Thirst in Hemodialysis Patients

Jung

Lee

et al. 2013

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Most dialysis centers adopt a standard dialysate sodium prescription. While pre-hemodialysis (HD) serum sodium levels remain relatively constant in each individual patient on chronic HD, these levels can vary between different patients. Therefore, a single dialysate sodium prescription may not be appropriate for all patients. Nineteen stable patients on maintenance HD were dialyzed for 9 HD sessions with their current dialysis solutions, followed by another 9 sessions using individualized prescriptions created by aligning dialysate sodium levels to each patient's serum sodium concentration. Patients were divided into 2 groups according to whether the average pre-HD serum sodium concentration was higher than (higher serum sodium group, n = 13) or equal to (equal sodium group, n = 5) the standard dialysate sodium concentration. Pre-HD serum sodium levels remained constant during entire study period in both groups. In higher serum sodium group, interdialytic weight gain increased after implementation of the sodium alignment (2.0 ± 0.3 kg vs. 2.3 ± 0.4 kg; P = 0.008). Thirst scores also increased in patients whose dialysate sodium was increased by 4 mmol/L (n = 7) (6.4 ± 1.5 vs. 7.6 ± 1.5, P = 0.015). There were no significant changes in blood pressure and intradialytic complications. In equal sodium group, significant differences were not observed in any parameters. Our results suggest that alignment of dialysate sodium levels to each patient's serum sodium concentration is of little benefit in hemodynamically stable patients who have pre-HD serum sodium concentrations higher than dialysate sodium concentration.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Increasing the Dialysate Sodium Concentration Based on Serum Sodium Concentrations Exacerbates Weight Gain and Thirst in Hemodialysis Patients

Jung

Lee

et al. 2013

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

show abstract

“…On the other hand, choosing a higher dialysate sodium relative to serum sodium concentration would help reduce the fall in plasma osmotic pressure, so improving refilling of the vascular compartment with more stable intradialytic hemodynamics. However, this approach risks a positive sodium balance, if appropriate ultrafiltration losses cannot be achieved . A positive sodium balance not only will result in systemic hypertension, but also increases fluid intake during the interdialytic period to restore the “osmolar setpoint,” so leading to greater interdialytic weight gain (IDWG).…”

Section: Introductionmentioning

confidence: 99%

Why does the choice of dialysate sodium concentration remain controversial?

Tangvoraphonkchai

Davenport

2018

Hemodialysis International

View full text Add to dashboard Cite

The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration. Although most studies have reported a reduction in IDWG with lower dialysate sodium concentrations, the effects on blood pressure control, and adverse intradialytic events have been variable. Different outcomes between studies may be partially explained by patient selection, with differences in dietary sodium intake, urinary sodium losses, and sodium stores in the body. In addition, multicenter trials potentially introduce additional confounders, including differences in local quality control of delivered dialysate sodium concentration and sodium measurements. Although there may be advantages for lower dialysate sodium concentration, observational studies have reported a survival advantage for higher dialysate sodium concentrations for those patients with lower serum sodium concentrations pre-dialysis. As there is no current consensus for a universal dialysate sodium concentration, attention has turned to considering an individualized approach to choosing a dialysate sodium concentration.

show abstract

“…2 Evidence of this sodium setpoint (SP) is also seen in thrice weekly conventional hemodialysis patients. [3][4][5] However, hemodialysis patients lack the mechanisms to regulate body osmolality and fluid balance. Although previous trials examining the clinical effects of different dialysate sodium concentrations have treated predialysis sodium setpoint as stable, this assumption has not been confirmed in quotidian hemodialysis patients.…”

mentioning

confidence: 99%

Plasma Sodium Setpoint

Thomson

Huang²,

Chan³

et al. 2013

ASAIO Journal

View full text Add to dashboard Cite

Stability of predialysis sodium "setpoint" has not been validated in quotidian dialysis patients. We performed a retrospective review of our home hemodialysis program, to determine the effect of transitioning from conventional thrice weekly to home hemodialysis modalities differing in dialysis duration and frequency (n = 87). Mean sodium setpoint remained constant in patients who went home on intermittent hemodialysis, but decreased by 100 days in frequent nocturnal home hemodialysis (FNHD) (140.5-137.1 mM, p = 0.001) and short hours daily hemodialysis (SHD) (140.2-138.7 mM, p = 0.019) patients with a pretransition setpoint greater than dialysate sodium of 140 mM. Slope of predialysis sodium concentration within the first 100 days post-transition (M100) was less than zero in SHD (95% confidence interval [CI], -0.0081 to -0.0351 mM/day) and FNHD (95% CI, -0.0209 to -0.0695 mM/day) patients who started with a pretransition setpoint greater than dialysate sodium concentration of 140 mM. Change in sodium setpoint (SP) was predicted by dialysis frequency and the difference between dialysate sodium concentration and the pretransition predialysis sodium concentration (R = 35.4%, adjusted R = 33.8%, p < 0.001). Thus, personalizing dialysate sodium concentrations may be associated with a decrease in SP, which is independently associated with increased mortality. Further research is required to determine whether intentional increases in the SP could improve cardiovascular and all-cause mortality.

show abstract

Sodium setpoint and gradient in bicarbonate hemodialysis

Abstract: A relatively "fixed" and individual osmolar setpoint in HD patients was shown for the first time in a long-term follow-up. A dialysate sodium concentration of 140 mmol/L determined a dialysate to plasma sodium gradient.

Cited by 30 publications

References 0 publications

Increasing the Dialysate Sodium Concentration Based on Serum Sodium Concentrations Exacerbates Weight Gain and Thirst in Hemodialysis Patients

Increasing the Dialysate Sodium Concentration Based on Serum Sodium Concentrations Exacerbates Weight Gain and Thirst in Hemodialysis Patients

Why does the choice of dialysate sodium concentration remain controversial?

Plasma Sodium Setpoint

Contact Info

Product

Resources

About