The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 1; pp. 138 - 144
• Main Authors: Moret, Karin, Aalten, Jeroen, van den Wall Bake, Warmold, Gerlag, Paul, Beerenhout, Charles, van der Sande, Frank, Leunissen, Karel, Kooman, Jeroen
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2006; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biological Transport; Blood Volume Determination; Cross-Over Studies; Dialysis Solutions - administration & dosage; Electric Conductivity; Emergency and intensive care: renal failure. Dialysis management; Feedback; Female; Glomerulonephritis; Humans; Hypertension; Hypotension - diagnosis; Hypotension - etiology; Hypovolemia - diagnosis; Hypovolemia - etiology; Intensive care medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pharmacology. Drug treatments; plasma conductivity; Probability; Renal Dialysis - adverse effects; Renal Dialysis - methods; Sensitivity and Specificity; Sodium - blood; sodium profiling; Ultrafiltration - instrumentation; Ultrafiltration - methods; Urinary system; Water-Electrolyte Balance; Kidney disease; Human; Hypertension; plasma conductivity; Urinary system disease; sodium profiling; Hemodialysis; Conductivity; Cardiovascular disease; Extrarenal dialysis; Sodium; Renal failure; Dialysis
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfi118

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.