Decision of dialysate sodium concentration appropriate for each dialysis patient from the standpoint of the prevention of high reninemia, highblood pressure, tetanic attack and thirst feeling

• Published in: The Japanese Journal of Nephrology Vol. 19; no. 5; pp. 383 - 389
• Main Authors: Haruyama, Takeshi, Shitomi, Kozo, Son, Hiyogi, Takeuchi, Mutuo, Kaneda, Hiroshi, Murata, Toyoaki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Nephrology 1977
• ISSN: 0385-2385; 1884-0728
• DOI: 10.14842/jpnjnephrol1959.19.383

To maintain a proper sodium balance of the body may be one of the most important key points to undergo the long-term dialysis treatment to be well. Dialysate supply system was carried out by a 50 L recirculation closed system and so, solutes dialysed-out from the body were easily measured in every dialysis, for example, removed sodium, removed water and removed sodium/water ratio. Therefore, in order to decide the dialysate sodium concentration appropriate for each dialysis patient, we studied the interrelationship between dialysate factors (dialysate sodium concentration, removed sodium, removed water and removed sodium/wate ratio) and plasma renin activity (PRA), blood pressure, tetanic attack and thirst feeling in 63 regular dialysis patients from December 1972 to August 1976, We though following conclusions to be important. 1) Prevention of high reninemia and hypertension We already reported that resting PRA and PRA ratio (post-dialysis PRA/pre-dialysis PRA) was closely related to removed sodium/water ratio in dialysis patients. Furthermore, it was demonstrated in this study-that high removed sodium/water ratio (200 mEq/L or more) caused severe hypertension. Therefore, suitable removed sodium/water ratio for the prevention of high reninemia, increased PRA ratio and hypertension in each patient was 200 mEq/L or less. In other words, it weaned that the dialysate sodium concentration was 135 mEq/L or more. 2) Prevention of tetanic attck We frequently encountered tetanic attack during dialysis, when the dialysis was carried out by such a removed sodiu/water ratio as 200 mEq/L or more, Then the dialysate sodium concentration of 135 mEq/L or more was proper for the prevention of tetanic attack. 3) Prevention of thirst feeling When removed sodium/water ratio was 160 mEq/L or less, dialysis patients often complained of severe thirst feeling. Then suitable dialysate sodium concentration against thirst feeling was 138 mEq/L or less. From these results, it concluded that the appropriate maintenance dialysate sodium concentrations for each dialysis patient were between 135 mEq/L to 138 mEq/L.