Hydrostatic Ultrafiltration During Hemodialysis Using Decreasing Sodium Dialysate

Chen, Wei-Tzuoh; Ing, Todd S.; Daugirdas, John T.; Humayun, Hamid M.; Brescia, Donald; Gandhi, Vasant C.; Hano, Jessie E.; Kheirbek, A O

doi:10.1111/j.1525-1594.1980.tb03932.x

Cited by 13 publications

(3 citation statements)

References 7 publications

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“…The same objective -reduction of total body sodium without fluid removal and better control of hypertension -may possibly be reached with the new technique of sequential sodium therapy [19]. This can be applied dur ing the dialysis session without increase of the total treat ment time.…”

Section: Discussionmentioning

confidence: 97%

Salt Subtraction in Patients on Maintenance Hemodialysis

D'amore¹,

Wauters²,

Waeber³

et al. 1985

Am J Nephrol

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In 6 hypertensive patients with terminal renal failure maintained on hemodialysis, the effects of ‘salt subtraction’ and of sequential Ultrafiltrating were evaluated. Following each of 3 weekly hemodialysis sessions, salt subtraction was carried out by Ultrafiltrating 1 liter and simultaneously infusing an equal volume of 5 % dextrose. This resulted in a net sodium loss without hypovolemia. After a 2-week period of this procedure, the blood pressure prior to dialysis was lower (156/76 ± 12/5 mm Hg) than after a comparable number of sequential Ultrafiltration sessions (181/88 ± 10/6 mm Hg; mean ± SEM). This difference was not statistically significant. At the same time, body weight was comparable at 64.4 ± 3 and 64.7 ± 4 kg, respectively. Neither plasma renin activity nor plasma catecholamines responded with a clear increase to either procedure. The limited effect on blood pressure and the renin system of a marked sodium removal during salt subtraction suggests that sodium must still be present in excess in these patients. The procedure of salt subtraction appears safe and subjectively well tolerated, but it can probably not be used as the sole means of decreasing total body sodium without associating dietary measures to reduce sodium intake.

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Section: Discussionmentioning

confidence: 97%

Salt Subtraction in Patients on Maintenance Hemodialysis

D'amore¹,

Wauters²,

Waeber³

et al. 1985

Am J Nephrol

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“…However, high sodium concentration in dialysate also increases thirst and interdialytic weight gain (IDWG), which enlarges the amount of UF needed during the treatment. 6,7 Moreover, it elevates ambulatory blood pressure (BP), secondary to a rise in plasma sodium concentration, which is closely related to cardiovascular morbidity and mortality. [8][9][10] It has also been proposed that lower dialysate sodium concentrations may have beneficial effects on endothelial function, oxidative stress, and other inflammatory markers.…”

Section: Introductionmentioning

confidence: 99%

Impact of dialysate sodium concentration on vascular refilling

Nadal

Martín-Capón

Viera-Ramírez

et al. 2021

Hemodialysis International

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Background: Although relationship between dialysate sodium concentration and hemodynamic stability has been well studied over the years, outcomes of absolute blood volume (ABV) maintenance and vascular refilling volume (V ref ) modifications were not included, as its analysis has not been easily accessible to direct investigation. However, recent studies report a simple and feasible methodology to assess ABV and V ref during hemodialysis (HD) treatments. It is the aim of this study to analyze whether sodium concentration in dialysate modifies ABV drop and V ref . Methods: The study was performed in 19 patients under HD. During three different sessions, sodium concentration in dialysate was randomized to three different profiles: low sodium concentration (LNa, 138 mEq/L), neutral sodium concentration (NNa, 140 mEq/L), and high sodium concentration (HNa, 143 mEq/L). ABV and V ref were calculated using Kron et al methodology. Results: Predialysis values of the measured parameters showed similar results for the three profiles. Sodium concentration showed an effect on ABV drop, V ref, and vascular refilling fraction (F ref ). Pair-wise comparison revealed mean ABV decreased 0.21 L less when using HNa profile versus LNa profile (p = 0.027), a mean V ref increase of 0.39 L (p = 0.038), and a mean F ref increase of 9.94% (p = 0.048). Conclusions: This study shows that the use of HNa profiles increases V ref and F ref and reduces ABV drop during dialysis treatments when compared to LNa profiles.

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“…In an attempt to reap the benefits of high-sodium dial ysis, and yet avoid its complications, we [14,15] and others [16] devised a method referred to as 'sodium gra dient' dialysis. With our proposed technique, dialysate sodium level is set at a high level (160 mEq/1) at the onset of dialysis.…”

Section: Introductionmentioning

confidence: 99%

A Double-Blind Evaluation of Sodium Gradient Hemodialysis

et al. 1985

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In a double-blind, crossover trial, 7 chronic hemodialysis patients underwent three 4-week treatment periods. During one period, dialysate contained 135mEq/l sodium. During another period, dialysate contained 143 mEq/l sodium. During the remaining period, we used ‘sodium gradient’ dialysate, the sodium concentration of which was decreased from 160 to 133 mEq/l during each 4-hour dialysis session. Ultrafiltration was performed at a constant rate to achieve a predetermined post-dialysis weight. Interdialytic weight gain, thirst, blood pressure control, and incidence of side effects were monitored. There was a significant difference in interdialytic weight gain for the 3 treatments (p = 0.005). Interdialytic weight gain using 135mEq/l sodium dialysate (2.2 ± 0.9 kg, mean ± SD) was significantly less than that using either 143 mEq/l sodium dialysate (2.6 ± 0.8 kg) or sodium gradient dialysate (2.8 ± 0.7 kg). Self-reported thirst tended to be less severe with 135 mEq/l sodium dialysate than with 143 mEq/l sodium dialysate or with sodium gradient dialysate, but changes in thirst were not statistically significant (p = 0.13). The incidence of intradialytic hypotensive episodes was comparable with the 3 levels of dialysate sodium. The results suggest that the described sodium gradient method does not prevent the increased interdialytic weight gain and thirst seen with other forms of high-sodium dialysis, and probably does not reduce the incidence of side effects.

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Hydrostatic Ultrafiltration During Hemodialysis Using Decreasing Sodium Dialysate

Cited by 13 publications

References 7 publications

Salt Subtraction in Patients on Maintenance Hemodialysis

Salt Subtraction in Patients on Maintenance Hemodialysis

Impact of dialysate sodium concentration on vascular refilling

A Double-Blind Evaluation of Sodium Gradient Hemodialysis

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