Improving volume status by comprehensive dietary and dialytic sodium management in chronic hemodialysis patients.
Chronic volume overload is highly prevalent in chronic hemodialysis patients and leads to hypertension, left ventricular hypertrophy and increased hospitalization and mortality rates. Volume overload is caused primarily by a positive sodium balance and can be improved by sodium restriction. The main sources of sodium excess are a high-sodium diet in the interdialytic period and a positive sodium balance during dialysis. Here we discuss different approaches to achieve neutral or negative sodium balance, including reducing dietary sodium intake, individualizing dialysate sodium prescription, abandonment of sodium profiling, and reducing saline infusion for treatment of intradialytic symptoms and as part of dialyzer rinsing and priming procedures. All of these approaches should be combined for a maximal reduction of volume overload.
Penne
E Lars
EL
Renal Research Institute and Beth Israel Medical Center, New York, NY, USA. larspenne@yahoo.com
Levin
Nathan W
NW
Kotanko
Peter
P
D001810:Blood Volume; D001826:Body Fluids / Q000737:chemistry; D004039:Diet, Sodium-Restricted; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000628:therapy*; D006435:Renal Dialysis; D012964:Sodium / Q000097:blood*; D016896:Treatment Outcome
D012964:Sodium