A new approach to individualize dialysis fluid sodium concentration using a four‐stream, bicarbonate‐based fluid delivery system

Lew, Susie Q.; Cheng, Yuk Lun; Tzamaloukas, Antonios H.; Ing, Todd S.

doi:10.1111/aor.13929

Cited by 3 publications

(6 citation statements)

References 14 publications

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“…Dialytic methods employed in the treatment of hyponatremia include CRRT methods, intermittent hemodialysis, and peritoneal dialysis. Table 4 contains reports of management of hyponatremia by dialytic methods (115)(116)(117)(118)(119)(120)(121)(122)(123)(124)(125)(126)(127)(128)(129)(130). One issue that requires further study in hyponatremia treated by hemodialysis is the effect of a decrease in plasma urea concentration during the procedure.…”

Section: Treatment Of Hyponatremia By Dialytic Methodsmentioning

confidence: 99%

“…Hypernatremia is corrected by hemodialysis by modifying the sodium concentration in the hemodialysis fluid ( 124 , 127 , 144 ). The rate of correction of hypernatremia should be the same as in the section of treatment in patients with CKD not on dialysis.…”

Section: Reviewmentioning

confidence: 99%

“…For this reason, the sodium concentration in the dialysis fluid should not differ from [Na] greatly and dialysis should be slow as detailed in the section on the treatment of hyponatremia by hemodialysis. A proposed novel method of producing dialysis fluid allows a larger range of sodium concentration in the dialysis fluid without altering the concentrations of other important ingredients, e.g., potassium and calcium, in this fluid ( 127 ). Correction of hypernatremia by peritoneal dialysis is done by lowering the sodium concentration of the dialysis fluid ( 25 ) or by using the commercial dialysis solution in documented acute cases in which hypernatremia can be treated at a fast rate ( 145 ).…”

Section: Reviewmentioning

confidence: 99%

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Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

Arzhan

Lew²,

Ing³

et al. 2021

Front. Med.

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The decreased ability of the kidney to regulate water and monovalent cation excretion predisposes patients with chronic kidney disease (CKD) to dysnatremias. In this report, we describe the clinical associations and methods of management of dysnatremias in this patient population by reviewing publications on hyponatremia and hypernatremia in patients with CKD not on dialysis, and those on maintenance hemodialysis or peritoneal dialysis. The prevalence of both hyponatremia and hypernatremia has been reported to be higher in patients with CKD than in the general population. Certain features of the studies analyzed, such as variation in the cut-off values of serum sodium concentration ([Na]) that define hyponatremia or hypernatremia, create comparison difficulties. Dysnatremias in patients with CKD are associated with adverse clinical conditions and mortality. Currently, investigation and treatment of dysnatremias in patients with CKD should follow clinical judgment and the guidelines for the general population. Whether azotemia allows different rates of correction of [Na] in patients with hyponatremic CKD and the methodology and outcomes of treatment of dysnatremias by renal replacement methods require further investigation. In conclusion, dysnatremias occur frequently and are associated with various comorbidities and mortality in patients with CKD. Knowledge gaps in their treatment and prevention call for further studies.

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Section: Treatment Of Hyponatremia By Dialytic Methodsmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

Arzhan

Lew²,

Ing³

et al. 2021

Front. Med.

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“…The co‐existing acetic acid, 4 mmoles/L in concentration and commonly provided by many stream A concentrates, down titrates the final [

{HCO}_{3}^{‐}

] df to 33 mmoles/L. An electronic pulley‐like mechanism, which sits between the W and S streams and changes the proportions of sodium chloride concentrate and water in the dialysis fluid without changing the proportions of the acid or base concentrates, enables [Na] df to vary without affecting the ingredients from the bicarbonate or acid concentrates 5 …”

Section: Methodsmentioning

confidence: 99%

“…We previously proposed a novel four-stream, tripleconcentrate, bicarbonate-based dialysis fluid delivery system to expand the range of sodium concentration in the dialysis fluid ([Na] df ) without changing the concentrations of the ingredients delivered from the acid and bicarbonate concentrates to the final dialysis fluid. 5 In this system, a 45×, four-stream, triple-concentrate, bicarbonate-based dialysis fluid delivery system consists of an acid concentrate stream, A; a sodium bicarbonate concentrate stream, B; a sodium chloride concentrate stream, S; and a product water stream, W. Table 1 shows the composition of streams S, A, and B. The normal flow rate ratios for W:S:A:B are 40.56:1.72:1:1.72, respectively (totaling 45 or 45×).…”

Section: A Variable Dialysis Fluid Sodium Approach Using a Four-strea...mentioning

confidence: 99%

A four‐stream method for providing variable dialysis fluid bicarbonate concentrations for bicarbonate‐based dialysis fluid delivery systems

et al. 2021

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Background Hemodialysis corrects metabolic acidosis by transferring bicarbonate or bicarbonate equivalents across the dialysis membrane from the dialysis fluid to the plasma. With the conventional three‐stream bicarbonate‐based dialysis fluid delivery system, a change in the bicarbonate concentration results in changes in the other electrolytes. In practice, the dialysis machine draws either a little less or more from the bicarbonate concentrate and a little more or less from the acid concentrate, respectively in a three‐stream delivery system. The result not only changes the bicarbonate concentration of the final dialysis fluid but also causes a minor change in the other ingredients. Methods We propose a four‐stream bicarbonate‐based dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a product water, and a new sodium chloride concentrate. Results By adjusting the flow rate ratio between the sodium chloride and sodium bicarbonate concentrates, one can achieve the desired bicarbonate concentration in the dialysis fluid without changing the concentration of sodium or ingredients in the acid concentrate. The chloride concentration mirrors the change in bicarbonate but in the opposite direction. Conclusion A four‐stream, bicarbonate‐based dialysis fluid delivery system allows the bicarbonate concentration to be changed without changing the other constituents of the final dialysis fluid.

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The role of intra- and interdialytic sodium balance and restriction in dialysis therapies

Lew,

Asci,

Rootjes

et al. 2023

Front. Med.

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The relationship between sodium, blood pressure and extracellular volume could not be more pronounced or complex than in a dialysis patient. We review the patients’ sources of sodium exposure in the form of dietary salt intake, medication administration, and the dialysis treatment itself. In addition, the roles dialysis modalities, hemodialysis types, and dialysis fluid sodium concentration have on blood pressure, intradialytic symptoms, and interdialytic weight gain affect patient outcomes are discussed. We review whether sodium restriction (reduced salt intake), alteration in dialysis fluid sodium concentration and the different dialysis types have any impact on blood pressure, intradialytic symptoms, and interdialytic weight gain.

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A new approach to individualize dialysis fluid sodium concentration using a four‐stream, bicarbonate‐based fluid delivery system

Cited by 3 publications

References 14 publications

Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

A four‐stream method for providing variable dialysis fluid bicarbonate concentrations for bicarbonate‐based dialysis fluid delivery systems

The role of intra- and interdialytic sodium balance and restriction in dialysis therapies

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