Sodium and Fluid Modulation in Dialysis: New Approach

Abstract

Hypotension during hemodialysis is still an unsolved problem. The treatment of patients with cardiovascular instability is efficaciously carried out with the use of ‘profiled dialysis’ (PD) with computerized modulation of ultrafiltration and conductivity. We tested a new profile model which involves progressive decrease of ultrafiltration associated with variable conductivity (‘bell pattern’). We observed 8 stable long-term patients receiving hemodialysis (4 men and 4 women, mean age 63.5 years) for 4 h three times a week. Before our test, sodium balance had reached a steady state in all patients and remained stable during the entire observation period. The sodium balance was established by means of a simple pattern suggested by Ursino and coworkers. The patients were observed for two periods of 1 month each (protocols A and B). The intradialytic mean arterial pressure was studied, checking every hour of dialysis. Statistical analysis was done by ANOVA for repeated measures. We compared standard dialysis with constant ultrafiltration rate and conductivity (protocol A) with sessions performed involving a progressive decrease of ultrafiltration together with a variable conductivity of –0.2, +0.2, +0.6, +0.6, 0, –0.4, –0.4, and –0.4 mS/s (protocol B). We found a lower incidence of hypotension (p < 0.01) with better cardiovascular stability during and after treatment in ‘profiled dialysis’.

Two Variable Sodium Profiles and Adverse Effects During Hemodialysis: A Randomized Crossover Study

“…The lower frequency of ISH during periods of VNa suggests that either profile is better than no profiling for persistently symptomatic patients. In a different setting, VNa associated with diverse UF modeling also induced fewer ISH episodes—no differences in interdialytic weight gain or pre‐ and post‐dialysis blood pressures were demonstrated (22,23). The reduction in the occurrence of ISH and cramps has been associated with linear profiling—no significant difference in the frequency of cramps could be demonstrated in the current study, even though cramps seemed to occur less often (17,19–21).…”

Minimally Invasive Video-Assisted Surgical Management for Parapharyngeal Metastases From Papillary Thyroid Carcinoma: A Case Series Report

“…The MIVA technique has been widely accepted in the management of benign or early malignant thyroid lesions. In 2005, Giordano et al (10) first described MIVA surgery for two PTC cases with PPLN metastases. Here, based on our previous experiences, we reported a case series of PTC patients with PPLN metastases managed with MIVA technique.…”