Relevance of the conductivity kinetic model in the control of sodium pool.
Changes in the body sodium pool caused by dialytic treatment have very important clinical implications, mainly in terms of intradialytic cardiovascular instability and interdialytic hyperhydration and hypertension with long-term cardiac hypertrophy and dilation. A kinetic model could be helpful in order to define the dialysate sodium concentration needed to match intradialytic hydrosodium removal with interdialytic sodium and water intake, but unfortunately, none of the sodium kinetic models are suitable for routine clinical application. Two conductivity kinetic models (one for hemodialysis and one for paired filtration dialysis) have been developed on the basis of the linear relationship between the sodium content and conductivity of every saline solution and plasma water and according to basic theory for ionic dialysance determination. These models make it possible to know at the start of each session the dialysate conductivity needed to obtain the desired final plasma water conductivity or to know the latter when the former is known. Clinical evaluations showed that conductivity kinetic models are very precise and accurate and may be used instead of sodium kinetic models. Furthermore, they are suitable for routine use because they do not require blood sampling or laboratory determinations. Clinical application of the conductivity kinetic model has shown that the reduced variability of end-dialysis plasma water conductivity obtained when using the model to identify dialysate conductivity significantly reduces cardiovascular instability, even without any changes in average sodium removal. Given that ionic dialysance can be easily, inexpensively, and repeatedly measured at each dialysis session, it seems realistic to expect that conductivity kinetic modeling will soon become a part of everyday clinical practice.
Department of Nephrology and Dialysis, Azienda Ospedale di Lecco, Lecco, Italy. nefrolec@tin.it
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Locatelli
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Di Filippo
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Manzoni
D001794:Blood Pressure; D015314:Dialysis Solutions / Q000493:pharmacokinetics; D006801:Humans; D007022:Hypotension / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy*; D007700:Kinetics; D008954:Models, Biological; D006435:Renal Dialysis; D012964:Sodium / Q000378:metabolism*; D014867:Water / Q000378:metabolism
D015314:Dialysis Solutions; D014867:Water; D012964:Sodium