The effect of profiled hemodialysis on intradialytic hemodynamics when a proper sodium balance is applied.
BACKGROUND
Profiled hemodialysis (HD) has been claimed to ameliorate intradialytic complications such as hypotension. Frequently, these profiles are based on providing the patient with an accumulating sodium load. This increases the risk of interdialytic complications, such as hypertension and increased weight gain. The present study investigated the effect of profiled HD, without an accompanying sodium loading, on intradialytic hemodynamics in stable HD patients.


METHODS
In eight stable HD patients a standard hemodialysis (S-HD) was compared to a decreasing Na(+)-profiled hemodialysis (Na-HD), and an ultrafiltration profiled hemodialysis (UF-HD). Care was taken to have the sodium balances similar during these sessions. The patients were monitored non-invasively during dialysis with respect to their cardiac performance by means of electrical impedance cardiography, their variation in blood volume by means of an on-line optical measurement, and their hydration state by means of body impedance analysis.


RESULTS
Sodium balance and mean arterial sodium concentrations were similar in the three treatments. Intradialytic hemodynamics during UF-HD were similar to those of S-HD. However, Na-HD improved blood pressure preservation, remarkably without significant blood volume preservation, due to a better stroke volume preservation in the first hour of dialysis.


CONCLUSIONS
Sodium-balanced, Na-profiled HD improves blood pressure preservation in stable HD patients without providing the patients with a sodium load. This effect is due to a better stroke volume preservation early in dialysis, without a significant reduction in blood volume decrease. UF-HD, as mono-therapy, has no beneficial effect on intradialytic hemodynamics in stable patients.
Straver
B
B
Department of Nephrology, Institute for Cardiovascular Research-VU (ICAR-VU), Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
De Vries
P M J M
PM
Donker
A J M
AJ
ter Wee
P M
PM
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001810:Blood Volume / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D015314:Dialysis Solutions / Q000592:standards; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000592:standards*; D012964:Sodium / Q000494:pharmacology / Q000592:standards*; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D015314:Dialysis Solutions; D012964:Sodium