The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients.
BACKGROUND
Sodium profiling improves haemodynamic tolerance in haemodialysis (HD) patients but may also influence sodium homeostasis. Changes in blood volume and plasma conductivity (PC) during HD can be modelled by feedback technology, but their effects on sodium homeostasis are not widely studied.


METHODS
This randomized crossover study compared PC and ionic mass balance (IMB) as surrogate markers of sodium balance between standard HD [dialysate conductivity (DC) 14.0 mS/cm], sodium profiling (DC 15.0-->14.0 mS/cm), blood volume (BV)-controlled and PC-controlled feedback (target: post-HD PC: 14.0 mS/cm) in 10 HD patients with frequent hypotension.


RESULTS
440 treatments were studied. Pre-dialytic PC was significantly higher during SP (14.4+/-0.2 mS/cm) compared to standard HD (14.2+/-0.3 mS/cm), and was not different between the other manoeuvres: PC-controlled (14.1+/-0.3 mS/cm), and BV-controlled feedback (14.2+/-0.2 mS/cm). Except for the first treatment, during which IMB was lower during the sodium profile, IMB did not differ significantly between the various manoeuvres and was strongly dependent upon ultrafiltration volume and the difference between pre-dialytic PC and DC. Symptomatic hypotensive episodes occurred least frequently during BV-controlled feedback (8%) compared to the other manoeuvres (standard HD, 16%; sodium profile, 14%; PC-controlled feedback, 17%), but differences were not significant. Inter-dialytic weight gain and pre-dialytic systolic blood pressure did not differ.


CONCLUSIONS
Pre-dialytic PC increased during the sodium profile, and did not differ between BV- or PC-controlled feedback compared to standard HD. Thus, it appears that both BV- and PC-controlled feedback can be safely prescribed without substantial salt- and water-loading, at least in the short term. Analysis of IMB is useful to assess differences in sodium balance between single treatment sessions but appears of less value in a steady-state situation.
Moret
Karin
K
Department of Internal Medicine, Maxima Medical Centre, Veldhoven and University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Aalten
Jeroen
J
van den Wall Bake
Warmold
W
Gerlag
Paul
P
Beerenhout
Charles
C
van der Sande
Frank
F
Leunissen
Karel
K
Kooman
Jeroen
J
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001692:Biological Transport; D001811:Blood Volume Determination; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000008:administration & dosage; D004553:Electric Conductivity; D005246:Feedback; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000209:etiology; D020896:Hypovolemia / Q000175:diagnosis* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011336:Probability; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012680:Sensitivity and Specificity; D012964:Sodium / Q000097:blood*; D014462:Ultrafiltration / Q000295:instrumentation / Q000379:methods; D014882:Water-Electrolyte Balance
D015314:Dialysis Solutions; D012964:Sodium