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. Copyright © 2010 S. Karger AG, Basel Received: March 23, 2010 Accepted: April 26, 2010 Published online: June 25, 2010 Lars Penne, MD, PhD Renal Research Institute 207 East 94th Street, Suite 303 New York, NY 10128 (USA) Tel. +1 212 360 4954, Fax +1 212 870 9767, E-Mail larspenne @ yahoo.com © 2010 S. Karger AG, Basel 0253–5068/10/0301–0071$26.00/0 Accessible online at: www.karger.com/bpu E.L.P. received a research fellowship from the Dutch Kidney Foun-