scholarly journals How to Adjust the Sodium Concentration in Dialysate Individually and Practically?

2021 ◽  
Vol 1 (2) ◽  
pp. 161-163
Author(s):  
Jingjing Zhang
Keyword(s):  
Serum Sodium ◽  
Observational Studies ◽  
Serum Sodium Level ◽  
Volume Overload ◽  
Sodium Concentration ◽  
Study Data ◽  
Chronic Hemodialysis ◽  
Low Sodium ◽  
Large Cohort Study ◽  
Dialysate Sodium

The optimal dialysate sodium concentration for chronic hemodialysis patients remains controversial. Conflicting data from small observational studies and large cohort study data have not convinced nephrologists to choose either a high or low sodium dialysate. Despite a lack of evidence, I would prescribe individualized dialysate sodium concentrations for patients with a risk of hypertension or volume overload, aligning the dialysate sodium concentration with patients’ predialysis serum sodium level. The concentration of dialysate sodium would usually be 0–2 mEq/L below the patient’s serum sodium concentration. I believe that this strategy would help improve hypertension, intradialytic weight gain, cardiac outcomes, and deliver precision medicine.

scholarly journals Increasing the Dialysate Sodium Concentration Based on Serum Sodium Concentrations Exacerbates Weight Gain and Thirst in Hemodialysis Patients

2013 ◽  
Vol 230 (2) ◽  
pp. 117-121 ◽  
Author(s):  
Eun Sook Jung ◽  
Jeonghwan Lee ◽  
Jay Wook Lee ◽  
Hyung-Jin Yoon ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Weight Gain ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Hemodialysis Patients ◽  
Dialysate Sodium

scholarly journals P1051WHICH MODEL OF DIALYSATE SODIUM PRESCRIPTION TO CHOOSE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natasha Eftimovska-Otovikj ◽  
Natasha Petkovikj ◽  
Elizabeta Poposka ◽  
Olivera Stojceva-Taneva
Keyword(s):  
Blood Pressure ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Sodium Balance ◽  
Hypertensive Patients ◽  
Interdialytic Weight Gain ◽  
Sodium Gradient ◽  
Set Up ◽  
Dialysate Sodium

Abstract Background and Aims The dialysate sodium prescription remain unclear as an important component of sodium balance in HD patients Pre-hemodialysis (pre-HD) serum sodium levels can vary among different patients, therefore, a single dialysate sodium prescription may not be appropriate for all patients. Dialysate sodium is one of the most easy changeable parameter which can influence hemodynamic stability. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of prescription of different models of dialysate sodium Method 77 nondiabetic subjects (41 men; 36 women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration set up at 138 mmol/L, followed by additional 3 models of dialysate sodium (each model performed 2 months sessions with 2 months standard dialysate sodium between each model) wherein dialysate sodium was set up: model 1: according to pre-HD serum sodium concentration, model 2: according to sodium concentration in UF fluid, model 3: sodium profiling ( from 144 to 136 mmol/L). Blood pressure (BP), interdialytic weight gain (IDWG), thirst score, sodium gradient were analysed. After the standard dialysate sodium hemodialyses, the subjects were divided into 3 groups: normotensive (N=58), hypertensive (N= 14) and hypotensive (N=5) based on the average pre-HD systolic BP during the standard dialysate sodium hemodialyses. Results Model 1: resulted in significantly lower blood pressure (133,61±11.88 versus 153.60±14.26 mmHg; p=0.000) and IDWG (2.21±0.93 versus 1.87±0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21±0.72 versus 2.06±0.65, p=0,004). Hypertensive patients had significant highest sodium gradient compared to other patients (p<0.05), followed by significant increase of 0,6% IDWG confirmed with univariate regression analysis. Thirst score was significantly lower in all patients with individualized-sodium HD and the use of antihypertensive drugs significantly reduced in hypertensive patients during the individualized phase. Model 2: resulted in significantly lower BP in normotensive and hypertensive patients (126.92±9.71 versus 124.08±8.71 mmHg; p=0.000; 153.60±14.26 versus 138.91±8.48 mmHg, accordingly), with no influence on IDWG, thirst score compared to standard dialysate sodium. Model 3: significantly higher BP and IDWG in all 3 groups (normotensive 126.92±9.71 versus 130.20±9.5 mmHg; p=0.001; IDWG 2.21±0.72 versus 2.34±0.82 kg, p=0,005; hypertensive 153.60±14.26 versus 157.58±5.0 mmHg; IDWG 2.21±0.93 versus 2.39±0.74 kg; p=0.005; hipotensive 79.81±11.78 versus 91.09±24.98 mmHg, IDWG 2.53±0.57 versus 2.73±0.15 kg, p=0.005) and significantly higher thirst score in normotensive and hypotensive patients, with no influence in hypertensive patients. Conclusion A reduction of the dialysate sodium concentration based on the pre HD serum sodium level of the patient, reduced the BP, IDWG, thirst score and use of antihypertensive drug compare to dialysate sodium according to sodium concentration in UF or sodium profiling. We recommend prescription of dialysate sodium according to pre HD serum sodium concentration.

Sodium Loading of Inner Ear Fluids

1976 ◽  
Vol 85 (6) ◽  
pp. 769-775 ◽  
Author(s):  
Herbert Silverstein ◽  
Tiero Takeda
Keyword(s):  
Sodium Chloride ◽  
Serum Sodium ◽  
Total Concentration ◽  
Sodium Concentration ◽  
Ionic Balance ◽  
Low Sodium ◽  
Minute Period ◽  
Concentration Of Ions ◽  
Before And After ◽  
Inner Ear Fluids

A slow intracarotid infusion of hypertonic sodium chloride solution, 350 mEq/L, and potassium chloride, 5 mEq/L, was used to increase serum sodium chloride over a 90-minute period in 85 cats. A slow, steady rise in serum sodium occurred, which reached almost 208 mEq/L at the end of 90 minutes. A concomitant rise in sodium occurred in the cerebrospinal fluid and perilymph. In contrast, the sodium showed only a transient slight increase in the cochlear and vestibular endolymph. Endolymph potassium appeared to rise in order to balance out the increase in sodium concentration of the surrounding and extracellular fluids. The ratio of sodium to potassium ions in both the endolymph and perilymph compartment remained relatively constant before and after the infusion with hypertonic NaCl. After infusion, the total concentration of ions in endolymph was similar to that of perilymph. These experiments indicate that the endolymph compartment has a built-in mechanism for maintaining a low-sodium concentration while keeping ionic balance with the surrounding perilymph and serum.

scholarly journals How Would You Prescribe the Dialysate Sodium Concentration for Your Patients?

2021 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Friedrich K. Port
Keyword(s):  
Blood Pressure ◽  
Recent Trend ◽  
Sodium Concentration ◽  
Intradialytic Hypotension ◽  
Sodium Removal ◽  
Low Sodium ◽  
Interdialytic Weight Gain ◽  
Increased Risk ◽  
Dialysate Sodium ◽  
Intradialytic Symptoms

Low sodium dialysate was commonly used in the early year of hemodialysis to enhance diffusive sodium removal beyond its convective removal by ultrafiltration. However, disequilibrium syndrome was common, particularly when dialysis sessions were reduced to 4 h. The recent trend of lowering the DNa from the most common level of 140 mEq/L has been associated with intradialytic hypotension and increased risk of hospitalization and mortality. Higher DNa also has disadvantages, such as higher blood pressure and greater interdialytic weight gain, likely due to increased thirst. My assessment of the evidence leads me to choose DNa at the 140 level for most patients and to avoid DNa below 138. Patients with intradialytic symptoms may benefit from DNa 142 mEq/L, if they can avoid excessive fluid weight gains.

scholarly journals HYPONATREMIA: IS IT RELATED TO THE SEASONS?

2021 ◽  
Author(s):  
Atila Altuntaş
Keyword(s):  
Relative Humidity ◽  
Negative Correlation ◽  
Serum Sodium ◽  
Sodium Level ◽  
Fluid Intake ◽  
Serum Sodium Level ◽  
Morbidity And Mortality ◽  
Electrolyte Disorder ◽  
Hypotonic Fluid ◽  
Low Sodium

Objectıve: Hyponatremia is a common electrolyte disorder in inpatients and related with morbidity and mortality. In this study we aimed to examine whether there is a relationship between incidence of hyponatremia among patients hospitalized in our nephrology department and the seasons. Material and Methods: Inpatients in our Nephrology Department between 2012-2015 were retrospectively analyzed. Patients with serum sodium levels below 135 mEq / L were included in the study. Hyponatremia incidence was calculated as the proportion of inpatients with low sodium levels in a season to total number of inpatients in the same season. Results: Out of 1950 inpatients in four-years period, 509 were found to have hyponatremia (26.1%). Mean serum sodium level of the patients was 129.7±4.7 mEq/L. Hyponatremia incidences in autumn, winter, spring and summer were found to be 28.7%, 15.4%, 20.4% and 36.6% respectively. Comparing the incidence of hyponatremia in patients hospitalized in winter and summer seasons, there was a significantly higher incidence of hyponatremia in summer (p <0.001). We found a positive correlation between hyponatremia incidence and temperature (r = 0.867, p = 0.001). However, there was a negative correlation between hyponatremia incidence and relative humidity (r =-0.735, p = 0.001). Conclusion: The highest hyponatremia incidence was observed in summer in four-year period. Loss of sodium by perspiration along with increased temperature and/or excessive hypotonic fluid intake might contribute to development of hyponatremia.

scholarly journals A case of cirrhosis with severe hyponatremia

2017 ◽  
Vol 1 (6) ◽  
Author(s):  
Yatendra Singh ◽  
Subhash Chandra Joshi ◽  
Mohammad Khalil ◽  
Ramlal Ola
Keyword(s):  
Serum Sodium ◽  
Serum Sodium Level ◽  
Alcoholic Cirrhosis ◽  
Sodium Concentration ◽  
Symptomatic Improvement ◽  
Serum Sodium Concentration ◽  
Decompensated Cirrhosis ◽  
Restricted Diet ◽  
Frequent Monitoring ◽  
History Of

Cirrhosis of the liver commonly leads to a state of chronic hypervolemic hyponatremia. Profound exacerbation of the hyponatremic state may occur in patients with decompensated cirrhosis in conjunction with acute stressors such as infection. Hyponatremia in cirrhosis is associated with increased morbidity and mortality. we report a case of52 year old man with a history of alcoholic cirrhosis presented to the hospital with symptomatic profound hyponatremia (serum sodium concentration of 102 meq/L). The patient was treated with antibiotics, diuretics and hypertonic saline and was placed on a fluid restricted diet. The serum sodium level corrected slowly over four days with symptomatic improvement occurring after five days. In patients with cirrhosis, it is important to recognize the symptoms of hyponatremia, identify and treat any exacerbating conditions early in their course, and correct the serum sodium concentration slowly with frequent monitoring. Key words: hyponatremia, cirrhosis, liver

MO724IS INDIVIDUALIZED DIALYSATE SODIUM REASON FOR BETTER SURVIVAL IN HEMODIALYSIS PATIENTS?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Natasha Eftimovska-Otovikj ◽  
Natasha Petkovikj ◽  
Olivera Stojceva-Taneva
Keyword(s):  
Serum Sodium ◽  
Well Being ◽  
Sodium Concentration ◽  
Left Ventricular ◽  
Serum Sodium Concentration ◽  
Laboratory Parameters ◽  
Interdialytic Weight Gain ◽  
Sodium Gradient ◽  
Set Up ◽  
Dialysate Sodium

Abstract Background and Aims We are uncertain about whether dialysate sodium improves overall health and well-being for people on haemodialysis, since there are a mixture of probably good and bad effects. Dialysate sodium is one of the most easy changeable parameter which can influence hemodynamic stability, echocardiography and laboratory parameters. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium. Method 77 nondiabetic subjects (41men; 36women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration setup at 138 mmol/L, followed by additional 24 month ssessions wherein dialysate sodium was set up according to pre-HD serum sodium concentration. Interdialytic weight gain (IDWG), echocardiography, laboratory parameters and survival were analysed. Results Sodium individualization resulted in significantly lower IDWG by using individualized sodium according to pre HD serum sodium compared to standard dialysate sodium (2.17±0.79 vs 1.93±0.64 kg, p&lt;0,001). In all patients we confirmed positive sodium gradient and univariate regression analysis showed that by increasing the sodium gradient by 1 mmol/L, IDWG increased by an average of 0.189% and 7,1% changes in IDWG can be explain by changing of the sodium gradient. Echocardiography analysis showed an increase of 2.04 mm of left ventricular diastolic diameter (LVDD) by increasing the sodium gradient for 1mmol/L and significantly increased left ventricular mass (LVM) of 35.69 gr by 1kg increase of IDWG. Laboratory analysis showed statistical significant increase in Kt/V, URR (urea reduction rate), serum albumin and hemoglobin by using individualized dialysed sodium compared to standard dialysate sodium, respectively (1.50±0.24 vs 1.36±0.22; 70.80±5.24 vs 67.00±6.23%; 38.23±3.80 vs 34.46±2.53 g/L; 120.32±10.14 vs 114.62±10.34 g/L, p&lt;0.001). We confirmed significant decrease in serum potassium, with no change in other electrolities (5.62±0.60vs 5.15±0.94). During the study, 7 patients died and binary logistic regression univariate analysis showed that significant predictors of mortality in patients dialyzed with individualized sodium dialysis according to pre-HD plasma sodium concentrations were Kt/V, URR, and CRP (C reactive protein). Analysis showed that patients with Kt/V lower than 1,2 have 8.8 times higher risk for death compared to patients with Kt/V&gt;1,2, URR lower than 65% have 10,9 times higher risk compared to URR&gt;65% and CRP higher than 10 mg/L have 10.2 times higher risk for death compared to patients with CRP lower than 10 mg/L Conclusion Individualization of dialysate sodium according to pre HD serum sodium concentration result in better IDWG control, improvement of fluid overload and regression of left ventricular hypertrophy, better dialysis adequacy and higher survival compared to standard dialysate sodium.

scholarly journals Impact of sodium profiling on ambulatory blood pressure in patients on maintenance hemodialysis

2017 ◽  
Vol 145 (3-4) ◽  
pp. 141-146
Author(s):  
Li-Hui Zhai ◽  
Yue-Yue Zhang ◽  
Yan Xu ◽  
Wen-Juan Yin ◽  
Lin Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Maintenance Hemodialysis ◽  
Interdialytic Weight Gain ◽  
Group A ◽  
Group B ◽  
Stage Renal Disease ◽  
Dialysate Sodium

Introduction/Objective. Most patients with end-stage renal disease (ESRD) have hypertension. However, dialysis-related strategies to optimize blood pressure in these patients remain controversial. The current study aims to investigate the influence of dialysate sodium profiling on ambulatory blood pressure (ABP) in patients on maintenance hemodialysis, when there are no adequate dialytic and economic resources or high patient compliance. Methods. This prospective, single-center study enrolled 60 hypertensive ESRD patients. Subjects received maintenance dialysis with regular dialysate sodium concentration (140 mmol/L) during the initial three months after the enrollment, and were randomly assigned to continue regular sodium dialysate (group A) or switch to sodium profiling (group B) for duration of three months. ABP, heart rate (HR), pre-/postdialysis serum sodium levels, antihypertensive treatment dosages, and interdialytic weight gain (IDWG) etc. were recorded after treatment assignment. Results. Thirty patients each were enrolled in groups A and B. The characteristics at baseline were not significantly different between the two groups. Compared to patients in group A three months later, patients in group B had lower systolic ABP (p = 0.00), HR (p = 0.04), IDWG (p = 0.04), and antihypertensive medication dosages (p = 0.04). Throughout the treatment duration, no significant inter-group differences were observed for pre-/post-dialysis serum sodium and intradialytic complications. Additionally, no significant correlations were found between systolic or diastolic ABP and other variables studied in this study. Conclusion. In this study, we found that dialysate sodium profiling successfully ameliorated hypertension and reduced BP medications without altering natremic levels or increasing complications among patients on maintenance hemodialysis during the three months. Dialysate sodium profiling was relatively safe in this duration.

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