A meta‐analysis of sodium profiling techniques and the impact on intradialytic hypotension

Dunne, Nina

doi:10.1111/hdi.12488

Cited by 21 publications

(19 citation statements)

References 27 publications

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“…Despite the significant improvements and advanced dialysis technology [3–5], renal transplantation still remains the treatment of choice for end stage renal disease patients, and over the past decades the overall survival rate of kidney grafts has improved consistently. Moreover, because of the wide gap between organ supply and demand, there is a growing number of patients with kidney failure who inexorably accumulate on renal transplant waiting lists [6], as well as the number of renal transplant (RT) recipients with functioning grafts going to be exposed to pathogens [7].…”

Section: Introductionmentioning

confidence: 99%

Seroprevalence of a “new” bacterium, Simkania negevensis, in renal transplant recipients and in hemodialysis patients

Angeletti¹,

Biondi

Battaglino³

et al. 2017

BMC Nephrol

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Background Simkania negevensis is an obligate intracellular bacterium belonging to the family Simkaniaceae in the Chlamydiales order. It is considered an ubiquitous microorganism and aquatic environments may be involved as a source of infection for humans. It was just isolated in samples from domestic water supplies and from mains water supplies, like spa water or swimming pool water, confirming its ability to resist to the common chlorination treatments. Evidence indicates a possible role of the microorganism in respiratory tract infections, in gastroenteric disorders and in the pathogenesis of cardiovascular disease, furthermore it has hypothesized that it could play a role in lung transplant rejection. Prevalence and possible effects in nephrology are unknown.MethodsWe examined the occurrence of Simkania negevensis in two differents populations, both characterized by a high susceptibility to infectious complications: 105 hemodialysis patients, 105 renal transplant recipients and 105 healthy subjects through the IgG and IgA response to Simkania negevensis in their sera. Serum antibodies to Simkania negevensis were detected by a homemade ELISA performed according to the Kahane’s protocol. Furthermore water samples from hemodialytic circuit were collected, to evaluate Simkania negevensis resistance to usual treatment of disinfection.ResultsOur results were unexpected, showing a higher seroprevalence of antibodies against Simkania negevensis in the hemodialysis patients, compared to renal transplant patients (IgG 22% vs 9% - IgA 9% vs 3%). S. negevensis was isolated in all water samples analyzed.ConclusionsOur study detected for the first time the occurrence of S. negevensis in hemodialysis and in renal transplant patients. Our findings suggest that water used in hemodialysis could be one of the possible sources of S. negevensis infection, without clinical involvement risk for patients.

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Section: Introductionmentioning

confidence: 99%

Seroprevalence of a “new” bacterium, Simkania negevensis, in renal transplant recipients and in hemodialysis patients

Angeletti¹,

Biondi

Battaglino³

et al. 2017

BMC Nephrol

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“…Sodium profiling is a modified method of sodium gradient dialysis during which DNa follows a time‐dependent profile. It can increase the extracellular volume and prevent intradialytic discomforts, such as hypotension, muscle cramps, and disequilibrium syndrome; some studies have found an increase in IDWG and thirst during the sodium‐profiled dialysis therapy . In a randomized cross‐over study, the DNa was changed from 155 ‐ 160 mmol/L in the beginning to 140 mmol/L in the last hour of dialysis during the intervention period.…”

Section: Sodium Profilingmentioning

confidence: 99%

Dialysate sodium concentration: The forgotten salt shaker

Hanafusa

Tsuchiya

Nitta

2018

Seminars in Dialysis

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The concentration of sodium in dialysis fluid, a major determinant of extracellular fluid volume and blood pressure, plays a major role in the sodium balance in end‐stage renal disease patients. A low dialysate sodium concentration (DNa) reduces interdialytic weight gain (IDWG) and blood pressure and might help ameliorate endothelial dysfunction and inflammation. However, low DNa can also increase the incidence of hypotensive episodes and muscle cramps. Sodium profiling, as typically prescribed in which the DNa is ramped up from above 140 mEq/L to nonphysiological levels, might reduce hypotension in patients with hemodynamic instability but at the cost of the consequences of hypernatremia. Serum sodium concentrations of individual patients fall within a narrow range around a “sodium setpoint.” The sodium gradient, the difference between the sodium set point and the DNa, is associated more robustly with clinical outcomes than DNa itself. Sodium concentration presents several issues: the influence of the net negative charge of plasma proteins on sodium flux across the dialysis membrane (Donnan equilibrium); and the clinically important problems in measuring sodium levels. This article presents a review of the clinical effects of DNa and of basic aspects of sodium balance in hemodialysis patients.

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“…Intradialytic hypotension may accelerate RKF loss via ischemic insults and can be prevented by sodium and water restriction, dialysate cooling, sodium profiling (which is reserved for short-term use), changing the ultrafiltration profile, and acetate-free HDF [67-70]. Using loop diuretics in hemodialysis patients with considerable RKF can also lower interdialytic weight gain and eventually benefit the preservation of RKF [71].…”

Section: How To Protect Rkfmentioning

confidence: 99%

Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

Hur

Lee²,

Kalantar-Zadeh³

et al. 2018

Cardiorenal Med

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Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemodialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.

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A meta‐analysis of sodium profiling techniques and the impact on intradialytic hypotension

Abstract: AimsTo assess the effectiveness of haemodialysis sodium profiling techniques Background

Cited by 21 publications

References 27 publications

Seroprevalence of a “new” bacterium, Simkania negevensis, in renal transplant recipients and in hemodialysis patients

Seroprevalence of a “new” bacterium, Simkania negevensis, in renal transplant recipients and in hemodialysis patients

Dialysate sodium concentration: The forgotten salt shaker

Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

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