The Role of Sequential Ultrafiltration and Varying Dialysate Sodium on Vascular Stability During Hemodialysis

Po, Christopher L.; Afolabi, Mary; Raja, Rasib M.

doi:10.1097/00002480-199307000-00133

Cited by 8 publications

(5 citation statements)

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“…The incidence of disequilibrium syndrome was found to be reduced with the use of such profiles (reviewed in refs. 24 and 28). Increasing sodium profiles were less commonly employed; they were used to preserve the plasma volume during the last period of dialysis in cases where the ultrafiltration is still high.…”

Section: Sodium Profilingmentioning

confidence: 98%

“…37). Third, from Table 2 it is apparent that the majority (9,12,13,18,19,21,23–25,27,31,33, 38–41) of profiles used (17 of 23) add sodium by diffusion. They thus increase plasma sodium concentration during dialysis; this may partly explain the reported short‐term benefits.…”

Section: Sodium Profilingmentioning

confidence: 99%

“…With regard to the possibility of profiling causing sodium accumulation, it is worth noting that there was no follow‐up of predialysis and/or postdialysis sodium levels or of clinical signs of sodium accumulation in six of the studies (12, 20–22, 24,33). Clinical or laboratory signs of sodium accumulation were found in eight studies (9,13,19,23,25,27,29,31) but not in the other eight cases (4,14,18,26,28,30,32,34).…”

Section: Sodium Profilingmentioning

confidence: 99%

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A Critical Review of Sodium Profiling for Hemodialysis

Stiller

Bonnie-Schorn²,

Grassmann³

et al. 2001

Seminars in Dialysis

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In sodium profiling, the sodium concentration in the dialysis fluid, instead of being constant, follows a time-dependent profile over the course of a hemodialysis session. The main aim of this manipulation is to avoid osmotic disequilibrium by keeping plasma osmolality in the physiological range. Further advantages of sodium profiling are a reduction in the incidence of muscle cramps, improved sodium removal, and improved vascular stability. Many different profiles have been used by various investigators. However, if sodium profiling is not appropriately conducted, sodium accumulation with resulting augmented thirst, increase of interdialytic weight gain, and hypertension may result. Sodium accumulation may, in fact, explain the reduced intradialytic morbidity reported in some short-term sodium profiling studies. Randomized, double-blind studies meeting strict statistical criteria and providing a careful control to maintain equivalent sodium balances between the compared treatments are difficult to perform and have not yet been published. However, because sodium profiling has potential benefits, provided that sodium balance is carefully controlled, it should nevertheless be regarded as a tool that experienced nephrologists can use for the treatment of patients who experience intolerable side effects during standard dialysis.

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Section: Sodium Profilingmentioning

confidence: 98%

Section: Sodium Profilingmentioning

confidence: 99%

Section: Sodium Profilingmentioning

confidence: 99%

See 1 more Smart Citation

A Critical Review of Sodium Profiling for Hemodialysis

Stiller

Bonnie-Schorn²,

Grassmann³

et al. 2001

Seminars in Dialysis

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“…The direct pathophysiological cause of intradialytic hypotension is the reduction in the circulating volume induced by ultrafiltration (UF) ( 10–12) facilitated by the fall in extracellular osmolarity (particularly in the first half of the session) caused by removing osmotically active solutes, mainly sodium, and the resultant shift of fluids from the outside to the inside of the cell, increasing the intracellular and decreasing the extracellular volume. The most common approach to offsetting these imbalances is the use of extracorporeal techniques alternative to standard hemodialysis (mainly hemodiafiltration and its variants) based upon continuous intradialytic sodium administration with different modalities ( 7, 13–16) in an attempt to curb the drop in plasma osmolarity. This approach, however, may introduce the risk of creating in time an insufficient decrease or sometimes even an increase in the total sodium mass ( 17–19), often resulting in clinical complications due to water and sodium retention such as hypertension or left ventricular heart failure, thirst, fluid overload, etc.…”

mentioning

confidence: 99%

“…This approach, however, may introduce the risk of creating in time an insufficient decrease or sometimes even an increase in the total sodium mass ( 17–19), often resulting in clinical complications due to water and sodium retention such as hypertension or left ventricular heart failure, thirst, fluid overload, etc. ( 8, 13, 14).…”

mentioning

confidence: 99%

Clinical Use of Profiled Hemodialysis

et al. 1998

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The new population on dialysis today consists mainly of high risk patients (the elderly, diabetics, etc.) with high cardiovascular scores, and such vascular pathology is the most important predisposing factor for the occurrence of a frequent intradialytic clinical complication, vascular instability syndrome, which covers a range of clinical problems. Recently a new dialysis technique, profiled hemodialysis (PHD), has been set up and proposed for routine use. PHD consists of the clinical use of preestablished individual dialysis profiles aimed at antagonizing the changes in intradialytic plasma osmolarity by continuous modulation of dialysate sodium concentration throughout the whole extracorporeal session. In particular, PHD aims at reducing the fall of plasma osmolarity in the first half of the session (when it is higher) by reducing the sodium removal rate through increasing its dialysate concentration while taking into account the desired individual sodium balance to be reached at the end of the session. In this work, we report clinical experience with PHD compared to standard hemodialysis with constant sodium dialysate (SHD) in terms of its efficacy to maintain a more stable intradialytic blood volume (BV) and more stable hemodynamics. The PHD used in this work has been implemented by a mathematical model for computing the individual dialysate sodium profile which we have recently validated (Ursino M, Coli L, La Manna G, Grilli Cicilioni M, Dalmastri V, Guidicissi A, Masotti P, Avanzolini G, Stefani S, Bonomini V. A simple mathematical model of intradialytic sodium kinetics: "in vivo" validation during hemodialysis with constant or variable sodium. Int J Artif Organs 1996;19:393-403.). Eleven uremic patients affected by hypotension at the beginning of dialysis treatment were studied. Each patient first underwent an SHD treatment and 1 week later a PHD treatment. The 2 extracorporeal sessions (one on SHD and the other on PHD) were performed in each individual patient under identical operative conditions including the sodium mass removal by the end of the session and the ultrafiltration rate. The crit line and Doppler echocardiography were used to determine BV, cardiac output (CO), and stroke volume (SV) throughout the sessions. The mean blood pressure (MBP) and heart rate (HR) were simultaneously monitored. PHD was associated with a more stable intradialytic BV and more stable hemodynamics compared to SHD. The higher stability of BV and cardiac function (in terms of SV and CO maintenance) which was obtained above all in the first half of the PHD session was associated with a higher stability of the MBP and the HR. This resulted in an enhancement in cardiovascular tolerance to ultrafiltration throughout the session in all tested patients. In contrast, SHD in the same patients was characterized by early significant changes in BV and cardiovascular parameters resulting in a significant decrease of the MBP and a significant increase of the HR throughout the session and also 1 h after the end of dialysis. Our resul...

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The effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study

Paganini

Sandy

Moreno

et al. 1996

Nephrology Dialysis Transplantation

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Haemodynamic stability was greater during Protocol B than during Protocol A in all patients. Significantly less intervention was noted during Protocol B, despite the same dialysis delivery during both Protocols. Relative Blood volume changes were less during Protocol B, despite a greater total ultrafiltration. Variable sodium dialysate coupled with a variable ultrafiltration rate seems to be the preferred dialysis prescription for ICU ARF patients undergoing intermittent haemodialysis.

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The Role of Sequential Ultrafiltration and Varying Dialysate Sodium on Vascular Stability During Hemodialysis

Cited by 8 publications

References 0 publications

A Critical Review of Sodium Profiling for Hemodialysis

A Critical Review of Sodium Profiling for Hemodialysis

Clinical Use of Profiled Hemodialysis

The effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study

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