scholarly journals Sodium in Hemodialysis Fluid

2021 ◽  
Vol 1 (2) ◽  
pp. 152-153
Author(s):  
Sanjay Kumar Agarwal
Keyword(s):  
Weight Gain ◽  
Sodium Level ◽  
Intradialytic Hypotension ◽  
Interdialytic Weight Gain ◽  
Maintenance Dialysis ◽  
Dialysate Sodium

The principal aim of dialysis in relation to sodium is that dialysate sodium should not be low enough to cause intradialytic hypotension and cramps, and should not be high enough to cause interdialytic weight gain and hypertension. Dialysis sodium at 138 meq/L is supposed to be neutral and for most patients, this remains the standard sodium level for regular long-term dialysis. In my opinion, sodium should be changed temporarily from this level to 142 meq/L in selected patients only for a few dialysis sessions, where the cause of intradialytic hypotension is not obvious. In patients who regularly go into intradialytic hypotension and whose cause of intradialytic hypotension is unclear or cannot be corrected, sodium profiling should be used for maintenance dialysis. There is no consensus on the level of sodium, although I think 142 meq/L for the initial hour followed by a decrease to 138 meq/L in the last hour is sensible.

scholarly journals Opinion on the (Hemo)dialysate Sodium Prescription: Dialysate Sodium Prescription Should Not Be Considered in Isolation

2021 ◽  
Vol 1 (2) ◽  
pp. 154-156
Author(s):  
Khai Ping Ng ◽  
Indranil Dasgupta
Keyword(s):  
Weight Gain ◽  
Low Temperature ◽  
Sodium Concentration ◽  
Dialysis Patients ◽  
Short Term ◽  
Volume Management ◽  
Interdialytic Weight Gain ◽  
Dialysate Sodium ◽  
Cardiovascular Stability

With advances in hemodialysis technology and the desire to achieve cardiovascular stability during dialysis, prescribed dialysate sodium concentration has gradually increased over the years. Short-term trials suggest low dialysate sodium (<138 mEq/L) is beneficial in reducing interdialytic weight gain, pre- and post-dialysis BP, and predialysis serum sodium; but it increases intradialytic hypotensive episodes. We believe dialysate sodium prescription cannot be considered in isolation. Our approach is to use patient symptoms, meticulous fluid volume management and low temperature dialysate in conjunction with neutral dialysate sodium in managing our dialysis patients. Long-term trials are needed to inform optimum dialysate sodium prescription.

scholarly journals Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes

2018 ◽  
Vol 14 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Scott Sibbel ◽  
Adam G. Walker ◽  
Carey Colson ◽  
Francesca Tentori ◽  
Steven M. Brunelli ◽  
...  
Keyword(s):  
Weight Gain ◽  
Confidence Interval ◽  
Loop Diuretic ◽  
Loop Diuretics ◽  
Dialysis Initiation ◽  
First Year ◽  
Intradialytic Hypotension ◽  
Interdialytic Weight Gain ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Background and objectivesLoop diuretics are commonly used to manage nondialysis-dependent CKD. Despite benefits of augmented urine output, loop diuretics are often discontinued after dialysis initiation. Here, we assessed the association of the early decision to continue loop diuretics at hemodialysis start with clinical outcomes during the first year of dialysis.Design, setting, participants, & measurementsWe considered all patients on in-center hemodialysis at a large dialysis organization (2006–2013) with Medicare Part A and D benefits who had an active supply of a loop diuretic at dialysis initiation (n=11,297). Active therapy was determined on the basis of whether loop diuretic prescription was refilled after dialysis initiation and within 30 days of exhaustion of prior supply. Patients were followed under an intention-to-treat paradigm for up to 12 months for rates of death, hospitalization, and intradialytic hypotension and mean monthly values of interdialytic weight gain, serum potassium, predialysis systolic BP, and ultrafiltration rates.ResultsWe identified 5219 patients who refilled a loop diuretic and 6078 eligible controls who did not. After adjustments for patient mix and clinical differences, continuation of loop diuretics was associated with lower hospitalization (adjusted incidence rate ratio, 0.93; 95% confidence interval, 0.89 to 0.98) and intradialytic hypotension (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.92 to 0.99) rates, no difference in death rate (adjusted hazard ratio, 0.92; 95% confidence interval, 0.84 to 1.01), and lower interdialytic weight gain (P=0.03).ConclusionsContinuation of loop diuretics after hemodialysis initiation was associated with lower rates of hospitalization and intradialytic hypotension as well as lower interdialytic weight gain, but there was no difference in mortality over the first year of dialysis.

Dialysate bicarbonate variation in maintenance hemodiafiltration patients: Impact on serum bicarbonate, intradialytic hypotension and interdialytic weight gain

2016 ◽  
Vol 21 (3) ◽  
pp. 385-392 ◽  
Author(s):  
Márcio Viegas ◽  
Cristina Cândido ◽  
Joana Felgueiras ◽  
José Clemente ◽  
Sara Barros ◽  
...  
Keyword(s):  
Weight Gain ◽  
Intradialytic Hypotension ◽  
Serum Bicarbonate ◽  
Interdialytic Weight Gain

scholarly journals Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis

2020 ◽  
Author(s):  
Soraiya Manji ◽  
Jasmit Shah ◽  
Ahmed Twahir ◽  
Ahmed Sokwala
Keyword(s):  
Weight Gain ◽  
Univariate Analysis ◽  
Sodium Concentration ◽  
University Hospital ◽  
Exact Test ◽  
Interdialytic Weight Gain ◽  
Significant Difference ◽  
Blood Pressures ◽  
The Mean ◽  
Dialysate Sodium

Abstract BackgroundChronic kidney disease is highly prevalent across the globe with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.MethodsThis study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137meq/l and 140meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results41 patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137meq/l group and 2.35 for the 140meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). ConclusionThere was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain although further studies with a larger sample size are warranted.

scholarly journals MP539DIALYSATE BICARBONATE VARIATION IN PATIENTS ON REGULAR HEMODIAFILTRATION PROGRAM: IMPACT ON INTRADIALYTIC HYPOTENSION AND INTERDIALYTIC WEIGHT GAIN

2016 ◽  
Vol 31 (suppl_1) ◽  
pp. i520-i520
Author(s):  
Márcio Viegas ◽  
Cristina Cândido ◽  
Joana Felgueiras ◽  
José Clemente ◽  
Sara Barros ◽  
...  
Keyword(s):  
Weight Gain ◽  
Intradialytic Hypotension ◽  
Program Impact ◽  
Interdialytic Weight Gain

Clinical impact of personalized sodium prescriptions in hemodialysis

2022 ◽  
Vol 35 (4) ◽  
Author(s):  
Mariana Sousa ◽  
◽  
Cristina Santos ◽  
Susana Colaço ◽  
José Santos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Serum Sodium ◽  
Statistical Significance ◽  
Extracellular Volume ◽  
Qualitative Assessment ◽  
Sodium Balance ◽  
Patient Specific ◽  
Interdialytic Weight Gain ◽  
Dialysate Sodium

Dialysate sodium prescription is often standardized. In some patients, this can be hypernatremic compared to serum sodium, causing a positive sodium balance at the end of treatment that will contribute to increased extracellular volume and interdialytic weight gain. A prospective study was carried out to monitor and compare the clinical implications between different prescriptions of sodium dialysate (isonatremic versus hyponatremic hemodialysis). For that purpose, we included hemodialysis patients in treatment for at least 9 months. The individual sodium setpoint was determined through the median of pre-dialysis sodium measurements, carried out for 6 treatments. The prescribed dialysate sodium was equal to the setpoint (isonatremic period) for 4 weeks and then 2 meq/L inferior to the setpoint (hyponatremic period) for another 4 weeks. The main outcome was interdialytic weight gain. Secondary outcomes were ultrafiltration rate, blood pressure at the beginning of treatment, intradialytic complications, and qualitative assessment of symptoms. Twenty patients were included. Pre-dialysis serum sodium assessments in both periods tended to be patient specific with a stable value. The interdialytic weight gain was lower in the hyponatremic period (1.83±0.50 kg versus 2.04±0.58 kg) but without statistical significance (p value=0.387). The same trend was found in mean ultrafiltration and blood pressure. Dialysis complications were low in both periods. The percentage of cramps and hypotension requiring intervention was higher in the hyponatremic period with no statistically significant differences. Concerning thirst, there was a symptomatic improvement with sodium customization. This improvement was even more significant in the hyponatremic period. This study allowed us to reinforce the existence of a “sodium setpoint” for each patient and the importance of an individualized dialysis prescription. Our results suggest the safety of using isonatremic hemodialysis with improving patients’ symptoms. Regarding hyponatremic hemodialysis, despite being beneficial, it seemed to be associated with a higher number of complications.

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