Mannitol Infusion in Regular Haemodialysis Treatment for Chronic Renal Insufficiency

The decreases in serum osmolality as well as the rate of ultrafiltration during hemodialysis and the influence of each upon the side effects of this treatment were studied in 13 chronic stable dialysis patients. Mannitol (9 mosm/kg water) was infused in two out of four dialyses, in a double blind fashion. A solution of 5% glucose in water was used as control. 1 week after the treatment, there was no residual mannitol in the patients’ serum (p < 0.0005). The decrease in osmolality during dialysis was lower when the patients received treatment with mannitol than with placebo: 14.7 versus 25.0 mosm/kg water (p < 0.001). The symptoms during dialysis were much less severe when the patients received mannitol (p < 0.05). Analyzed separately, ultrafiltration rate had no effect on severity of symptoms during dialysis (p > 0.1). Decrease in serum osmolality during dialysis seems to be the most important factor in the genesis of dialysis symptoms in chronic stable dialysis patients and are counteracted by the infusion of an osmotically active substance such as mannitol, 1 g/kg/dialysis; this results in a slight increase in body weight between dialyses, and cannot be used routinely because of slow accumulation.

Section: Mannitol Levelsmentioning

confidence: 99%

The Importance of Osmolality Fall and Ultrafiltration Rate on Hemodialysis Side Effects

Rosa

Shideman

McHugh

et al. 1981

“…In fact, the administration of intravenous osmotic agents during dialysis [13, 25,26] and the use of high sodium concentration in the dialysis fluid [27] are associated with an improvement in vascular sta bility, absence of severe symptomatic hypotension, and a better tolerance to ultrafiltration. These clinical observa tions are probably related to the small decrease in plasma osmolality achieved when using either intravenous hy pertonic substances or hypertonic dialysate fluid.…”

Section: Discussionmentioning

confidence: 99%

Sequential Hypertonic Dialysis

Martín‐Malo

Perez

Gomez

et al. 1985

We have investigated the usefulness and practicability of the so-called sequential hypertonic dialysis in 2 selected patients with severe hemodialysis-induced hypotension; 190 mmol/l of sodium dialysate during the 1st and 3rd h and 132 mmol/l throughout the 2nd and 4th h were used, with a Drake-Willock-Bi proportionating unit, which was electronically modified for the purpose of the study. Crossover was made, patients serving as their own controls in two consecutive cycles: 3 weeks conventional hemodialysis followed by 4 weeks sequential hypertonic dialysis, using high-flux dialyzers. At the end of sequential hypertonic dialysis a greater weight loss was achieved (p < 0.001) with absolute stability of blood pressure. There were no significant changes in plasma osmolality and plasma volume during sequential hypertonic dialysis when compared with conventional hemodialysis. Dialysis symptoms and complications were less frequently recorded during sequential hypertonic dialysis (p < 0.001). At the end of each sequential hypertonic dialysis period, hemoglobin, potassium, and phosphate plasma levels improved significantly and plasma sodium concentrations remained within the normal range. We conclude that sequential hypertonic dialysis is an easy and routine feasible procedure with our methodology. It is possible to achieve the ideal dry weight with no symptomatic hypotension. Sequential hypertonic dialysis constitutes an alternative to sequential ultrafiltration in selected patients, as it minimizes the falloff in plasma volume and osmolality observed during conventional hemodialysis.

“…The amount of saline used, however, may not have been sufficient to affect intravascular volume and maintain an adequate perfusion in the area of muscle spasm. Other authors have reported alleviating cramps by increasing dialysate sodium concentration, by using shorter, more frequent dialyses, or by using mannitol [5,13].…”

Section: Discussionmentioning

confidence: 99%

“…There is general agreement in the literature that the pathogenesis of this syndrome probably lies in two factors that occur with the onset of dialysis: the develop ment of osmolar gradients between extracellular and intracellular fluid and the ultrafiltration of water [7,8,10,11]. The manipulation of one or both of these factors can relieve or curtail the symptoms [5,7,13].One component of the osmolar gradients is the colloid osmotic (oncotic) pressure (COP). It contributes very little to osmolality, but is the major intra vascular osmotically active force, and, thus, is a major factor in determining the status of interstitial and intracellular hydration.…”

mentioning

confidence: 99%

Colloid Osmotic Pressure Fluctuations and the Disequilibrium Syndrome during Hemodialysis

Cerra

Anthone

1974

Changes in colloid osmotic pressure (COP), osmolality, blood urea nitrogen, glucose, electrolytes and arterial blood gases were correlated with the symptoms that occurred during 46 dialyses in 10 stable, chronic hemodialysis patients who had symptoms attributable to the disequilibrium syndrome. The onset and severity of symptoms were consistently related to fluctuations in COP. Saline administration failed to relieve them, whereas the continuous infusion of salt-poor human serum albumin (1 g/kg) or mannitol (1 g/kg) successfully controlled the COP fluctuations and most of the symptomatology. The relationship of the COP fluctuations to existing theories on the pathogenesis of the disequilibrium syndrome were discussed.