Practical implementation and clinical benefits of the new automated dialysate sodium control biosensor

Abstract

Background A key point in dialysis treatment is the prescription of dialysate sodium (Na). This study aimed to describe the practical implementation of a new automated dialysate Na control biosensor and to assess its tolerance and the beneficial clinical effects of isonatremic dialysis. Methods A prospective study was carried out in 86 patients who, along with their usual parameters, received the following five consecutive phases of treatment for 3 weeks each: phase 0: baseline 5008 machine; phases 1 and 2: 6008 machine without activation of the Na control biosensor and the same fixed individualized Na dialysate prescription or adjusted to obtain similar conductivity to phase 0; phases 3 and 4: activated Na control to isonatremic dialysis (Na dialysate margins 135–141 or 134-142 mmol/L). Results When the Na control was activated, the few episodes of cramps or hypotension disappeared when the lower dialysate Na margin was increased by 1 or 2 mmol/L. The activated Na control module showed significant differences compared with baseline and the non-activated Na module in final serum Na values, diffusive Na balance, and changes in pre- to postdialysis plasma Na values. The mean predialysis systolic blood pressure value was significantly lower in phase 4 than in phase 1. There were no significant differences in total Na balance in the four 6008 phases evaluated. Conclusions The implementation of the automated dialysate Na control module is a useful new tool, which reduced the diffusive load of Na with good tolerance. The module had the advantages of reducing thirst, interdialytic weight gain, and intradialytic plasma Na changes.

Results of Salt Intake Restriction Monitored with the New Sodium Control Biosensor

“…In our study, the low-Na diet was associated with increased diffusive balance. As previously reported by our group [14], the determining factor in achieving a neutral diffusive balance was the pre-dialysis s Na value. As in the present study, the pre-dialysis s Na decreased by almost 2 mmol/L, which would explain this change.…”

“…However, these monitors could not be used with certain dialysis techniques, such as hemodiafiltration. The new 6008 CAREsystem monitors can be used with all types of dialysis modalities, including hemodiafiltration, and also incorporate a Na module that quantifies the total Na balance by providing approximate information on salt intake in stable patients on HD without residual renal function while ignoring other Na losses such as those in stool or sweat [14]. This study aimed to evaluate the effects of a restrictive Na intake diet versus usual Na intake on interdialytic weight gain, s Na, the difference between pre- and post-dialysis Na, known as delta Na (Δ s Na), diffusive Na balance, and systolic and diastolic blood pressure.…”