title: Avoiding harm and achieving optimal dialysis outcomes--the dialysate component.
abstract: Appropriate dialysate composition is critical for effective and safe hemodialysis. Unfortunately, there are few randomized trials to guide practice, and although solute clearance is well understood, there is a limited understanding of balance in dialysis patients. The current practice of simply trying to normalize serum electrolyte and mineral concentrations measured predialysis may not provide optimal care. More thought should be given to normalizing balance with respect to sodium, bicarbonate, magnesium, and potassium and minimizing wide swings in serum concentrations that may have adverse effects. In practice, this would require longer or more frequent dialysis with less steep chemical gradients. With respect to calcium, the goal should be to optimize bone and vascular health. Clinicians should also be mindful that the dialysis procedure itself exposes patients to potential toxins, and efforts to minimize these risks should be stressed.
authors.affiliation: Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Denver, CO, USA. david.spiegel@ucdenver.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Spiegel
mesh_terms: D004573:Electrolytes / Q000627:therapeutic use; D015312:Hemodialysis Solutions / Q000737:chemistry* / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D004573:Electrolytes; D015312:Hemodialysis Solutions