#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Sodium concentration in dialysate – an important but neglected parameter in haemodialysis of patients with chronic renal failure


Authors: F. Lopot 1,2;  F. Švára 1,3;  V. Polakovič 1,3
Authors‘ workplace: Interní oddělení Strahov VFN Praha, přednosta prim. MUDr. Vladimír Polakovič, MBA 1;  Ústav biofyziky a informatiky 1. lékařské fakulty UK Praha, přednosta prof. MUDr. RNDr. Jiří Beneš, CSc. 2;  Klinika nefrologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Vladimír Tesař, DrSc., MBA 3
Published in: Vnitř Lék 2012; 58(7 a 8): 60-65
Category: 80th Birthday MUDr. Miroslav Mydlík, DrSc.

Overview

Sodium ion with its accompanying anions plays the major role in osmolality of body fluids changes of which determine overall fluid balance in health given on one side by water intake and on the other side by its excretion via kidneys. In renal failure, control of the excess fluid removal is taken over by dialysis but control of water intake via thirst induced by changes in osmolality remains functional. Sodium balance is thus of utmost importance. It consists of two components – dietary salt intake and sodium balance during haemodialysis (HD). Choice of sodium concentration in dialysis solution (CDNa) and its difference from plasma sodium (CPNa) may thus significantly influence water intake during the interdialytic period. And despite of rather wide interindividual scatter in CPNa, majority of dialysis centres still uses the same CDNa value for all patients and their dietary counselling stresses the need of restriction in fluid intake only. The article analyzes possible impact (benefits) of the two principal approaches to CDNa manipulation – its individualisation with the value being kept constant during the whole HD session and use of sodium profiling (changing CDNa during the course of HD). Based on literary data and on own measurements, CDNa individualisation appears far more beneficial in the long-term perspective. Contemporary off-line sodium profiling, regardless of how sophisticated control algorithm is used brings in the risk of positive sodium balance with all negative effects associated with it. Restriction of salt intake should be stressed in dietary counselling instead of mere fluid restriction.

Key words:
haemodialysis – sodium concentration – sodium balance – weight gains – individualization – sodium profiling


Sources

1. Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialyis patients. Kidney Int 1999; 55: 1553–1559.

2. Morel K, Hassell D, Kooman JP et al. Ionic mass balance and blood volume preservation during a high, standard, and individualized dia­lysate sodium concentration. Nephrol Dial Transplant 2002; 17: 1453–1469.

3. Santos SFF, Peixoto AJ. Revisiting the dialysate sodium prescription as a tool for better blood pressure and interdialytic weight gain management in hemodialysis patients. Clin J Am Soc Nephrol 2008; 3: 522–530.

4. Santos SFF, Peixoto AJ. Sodium balance and maintenance hemodialysis. Semin Dial 2010; 23: 549–555.

5. Lomonte C, Basile C. Do not forget to individualize dialysate sodium prescription. Nephrol Dial Transplant 2011; 26: 1126–1128.

6. Peixoto AJ, Santos SFF. How should the predialysis plasma sodium be interpreted in hemodialysis patients? Semin Dial 2011; 24: 409–411.

7. Edelman IS, Leibman J, O’Meara MP et al. Interrelation between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest 1958; 37: 1236–1256.

8. Workeneh B, Balakumaran A, Bichet DG et al. The dilemma of diagnosing the cause of hypernatremia: drinking habits vs. diabetes insipidus. Nephrol Dial Transplant 2004; 19: 3165–3167.

9. Schűck O, Tesař V, Teplan V. Klinická nefrologie. Praha: Medprint 1995.

10. Lindley E. Reducing sodium intake in hemodialysis patients. Semin Dial 2009; 22: 260–263.

11. Hollenberg N. Surfeit, deficit and the set point for sodium homeostasis. Kidney Int 1982; 21: 883–884.

12. Bonventre JV, Leaf A. Sodium homeostasis, steady states without a set point. Kidney Int 1982; 21: 880–883.

13. Raja R, Po CL. Plasma refilling during hemodialysis with decreasing ultrafiltration. ASAIO J 1994; 40: M423–M425.

14. De Paula FM, Peixoto AJ, Pinto LV et al. Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int 2004; 66: 1232–1238.

15. Mendoza JM, Byes LY, Sun S et al. Effect of lowering dialysate sodium concentration o interdialytic weight gain and blood pressure in pa­tients undergoing thrice-weekly in-center nocturnal hemodialysis: a quality improvement study. Am J Kidney Dis 2011; 58: 956–963.

16. Flanigan MJ. Sodium. Semin Dial 2008; 21: 226–229.

17. Hecking M, Kainz A, Herner H et al. Sodium Setpoint and sodium gradient: influence on plasma sodium change and weight gain. Am J Nephrol 2011; 33: 39–48.

18. Lopot F, Bláha J, Kotyk P. Řízení koncentrace sodíku při hemodialýze, závěrečná zpráva projektu IGA MZ ČR, č. 1025-3. Praha 1995.

19. Arramreddy R, Sun SJ, Munoz-Mendoza J et al. Individualized reduction in dialysate sodium in conventional hemodialysis. Hemodial Int 2012; doi: 10.1111/j.1542-4758.2012.00701.x.

20. Lambie SH, Taal MW, Fluck RJ et al. On-line conductivity monitoring: validation and usefulness in a clinical trial of reduced dialysate conductivity. ASAIO J 2005; 51: 70–76.

21. Ogden DA. A double blind crossover comparison of high and low sodium dialysis. Proc Dial Transp Forum 1978; 8: 157–165.

22. Van Stone JC, Bauer J, Carey J. The effect of dialysate sodium concentration on body fluid distribution during hemodialysis. Trans Am Soc Artif Internal Organs 1980; 26: 383–386.

23. Gotch FA, Lam MA, Prowitt M et al. Preliminary clinical results with sodium volume modeling of hemodialysis therapy. Proc Dial Transpl Forum 1980; 10: 12–16.

24. Petitclerc T, Man NK, Funck-Brentano H. Sodium modeling during hemodialysis: a new approach. Artif Organs 1984; 8: 418–422.

25. Heineken FG, Evans MC, Keen ML et al. Intercompartmental fluid Shift in hemodialysis patients. Biotechnology Progress 1987; 3: 69–73.

26. Maeda K, Kawaguchi S, Kobayashi S et al. Cell-wash dialysis. Trans Am Soc Artif Internal Organs 1980; 26: 213–218.

27. Stiller S, Bonnie-Schorn E, Grassmann A et al. A critical review of sodium profilig for hemodialysis. Semin Dial 2001; 14: 337–347.

28. Coli L, Bonomini M, La Manna G et al. Clinical use of profiled hemodialysis. Artif Organs 1998; 22: 724–730.

29. Levin A, Goldstein MB. The benefits and side effects of ramped hypertonic sodium in dialysate. J Am Soc Nephrol 1996; 7: 242–246.

30. Santoro A, Mancini E, Paolini F et al. Blood volume regulation during hemodialysis. Am J Kidney Dis 1998; 32: 739–748.

31. Steward IJ, Henrich WJ. Is there any role for sodium modeling in the preventiv of intradialytic hypotension in patients with large interdialytic fluid gains? Semin Dial 2011; 24: 422–423.

32. Song JH, Lee SW, Suh CK et al. Time-averaged concentration of dialysate sodium relates with sodium load and interdialytic weight gain during sodium-profiling hemodialysis. Am J Kidney Dis 2002; 40: 291–301.

33. Lopot F. Clinical Use of Continuous Blood Volume Monitoring. EDTNA-ERCA J 1996; 22: 9–14.

34. Gotch F, Evans M, Metzner K et al. An On-line Monitor of Dialyzer Na and K Flux in Hemodialysis. ASAIO Trans 1990; 36: 359-361.

35. Manlucu J, Gallo K, Heidenheim PA et al. Lowering post-dialysis plasma sodium (conductivity) to increase sodium removal in volume expanded hemodialysis patients: a pilot study using a biofeedback software system. Am J Kidney Dis 2010; 56: 69.

36. Titze J. Water-free Na+ retention: interaction with hypertension and tissue hydration. Blood Purif 2008; 26: 95–99.

37. EBPG guideline on haemodynamic stability. Nephrol Dial Transplant 2007; 22 (Suppl 2): 22–44.

38. Shaldon S, Vienken J. Beyond the current paradigm: recent advances in the understanding of sodium handling. Semin Dial 2009; 22: 252.

39. Rupp JW, Stone RA, Gunning BE. Sodium vs. sodium-fluid restriction in hemodialysis: control of weight gains and blood pressures. Am J Clin Nutr 1978; 31: 1952–1955.

40. Keen ML, Gotch FA. The association of the sodium „setpoint“ to interdialytic weight gain and blood pressure in hemodialysis patients. Int J Artif Organs 2007; 30: 971–979.

41. Mendoza JM, Sun S, Chertow GM et al. Dia­lysate sodium and sodium gradient in maintenance hemodialysis: a neglected sodium restriction approach? Nephrol Dial Transplant 2011; 26: 1281–1287.

42. Ramdeen GR, Tzamaloukas AH, Malhotra D et al. Estimates of interdialytic sodium and water intake based on the balance principle, differences between nondiabetic and diabetic subjects on hemodialysis. ASAIO J 1998; 44: 812–817.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 7 a 8

2012 Issue 7 a 8

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#