Is Na+ modeling necessary in high flux dialysis?
One important pathogenic factor in dialysis hypotension is the drop in plasma osmolality. Increasing the dialysate Na+ concentration decreases hypotensive episodes. The authors studied 39 patients being treated with high flux dialysis. During a 9 week period, the patients were on a standard Na+ dialysate (Na+ = 140 meq/L) basal period (B); 9% (Na+ = 149 meq/L) linear (L); step drop (S); and exponential drop (E). The Na+ program was changed weekly at random. The results obtained with the three Na+ modeling programs were similar. We compared the periods with and without Na+ modeling: no differences were found in weight gained interdialysis, mean blood pressure predialysis and postdialysis, and hemoconcentration. Serum Na+ levels were significantly higher predialysis and postdialysis for those patients on Na+ modeling. Hypotensive episodes and cramps decreased 50% with Na+ modeling. The amount of hypertonic and normal saline given during dialysis was markedly reduced. Na+ modeling should always be used in patients being maintained on high flux dialysis.
Acchiardo
S R
SR
Department of Medicine, University of Tennessee-Memphis.
Hayden
A J
AJ
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007022:Hypotension / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D007688:Kidneys, Artificial; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000097:blood*; D012984:Software; D014882:Water-Electrolyte Balance / Q000502:physiology*
D012964:Sodium