Sodium and body fluid homeostasis in profiling hemodialysis treatment

Abstract

Acute adverse side-effects of hemodialysis such as hypotension, muscle cramps, osmotic imbalance and thirst are induced by the interference with fluid and electrolyte balance occurring during treatment. Changes in osmolarity due to alterations of plasma sodium concentration during hemodialysis strongly influence fluid distribution between extracellular and intracellular fluid volume. Increased sodium dialysate concentration induces fluid shift from the intracellular to the extracellular compartment. This shift leads to a more efficient ultrafiltration by increasing plasma refilling volume but also to an increased thirst. Treatment of hypotension, cramps and nausea with hypertonic saline solution leads also to a considerable retention of sodium. Profiling hemodialysis consists in deliberately changing ultrafiltration and dialysate. sodium in order to combine an efficient ultrafiltration with a balanced sodium handling and to prevent side-effects during treatment. Continuous measurement and control of blood volume seems to be the best method to prevent hypotensive episodes. Profiling of sodium should not be the cause of a positive sodium balance. The clinical benefits of sodium profiling to the patients have still to be proven.

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

“…Although a multitude of approaches has been tried [53] , the most common was application of a high ultrafiltration rate and high sodium concentration at the beginning of dialysis with a gradual or stepwise decrease in dialysate sodium concentrations and ultrafiltration rates throughout the dialysis session [54] . Whereas short-term studies showed improvement in the incidence of hypotensive episodes, a careful study of sodium balance showed that improvement was related to a positive sodium balance, leading to chronic volume overload, hypertension, myocardial hypertrophy, and increased cardiovascular mortality [55,56] .…”

Ocular Findings Before and After Hemodialysis in Patients with Chronic Renal Failure

“…16 Bu değişiklikler serumda, aköz ve vitreusu da içeren ekstraselüler sıvılarda ozmotik değişikliklere neden olarak, görme keskinliği ve refraksiyonu etkilemektedir. 17 Ayrıca, diyabet ve hipertansiyon gibi etiyolojik faktörler de fokal veya yaygın kapiller sızıntıya bağlı makulada ödem ve neticede görme keskinliğinde azalmaya neden olabilmektedir.…”

A need for a paradigm shift in focus: From Kt/Vurea to appropriate removal of sodium (the ignored uremic toxin)

“…Although a multitude of approaches has been tried, 111 the most common was application of a high ultrafiltration rate and high sodium concentration at the beginning of dialysis with a gradual or stepwise decrease in dialysate sodium concentrations and ultrafiltration rates throughout the dialysis session. 112 Whereas short-term studies showed improvement in the incidence of hypotensive episodes, a careful study of sodium balance showed that improvement was related to a positive sodium balance, leading to chronic volume overload, hypertension, myocardial hypertrophy, and increased cardiovascular mortality. 113,114 In addition to an increased mortality with rapid ultrafiltration, a recent DOPPS 95 also showed markedly higher odds of IDH episodes in patients with an ultrafiltration rate of >l0 mL/h/kg.…”