Sodium Gradient: A Tool to Individualize Dialysate Sodium Prescription in Chronic Hemodialysis Patients?
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چکیده
Low dialysate sodium concentrations have been associated with intradialytic symptoms such as muscle cramps and hypotensive episodes. High dialysate sodium concentrations lead to sodium loading, thirst and subsequent increase in interdialytic weight gain and hypertension. The optimal dialysate sodium concentration for an individual depends on the serum sodium concentration. The difference between the dialysate sodium concentration and the predialysis serum sodium concentration has been defined as the sodium gradient. In this article, the role of the sodium gradient in fluid overload, hypertension, intradialytic symptoms and clinical outcome is discussed. Absolute serum sodium levels should always be taken into account when interpreting the relation between sodium gradient and clinical outcomes. Alignment of the dialysate sodium with the serum sodium concentration may be beneficial in many patients. Copyright © 2011 S. Karger AG, Basel Published online: January 10, 2011 Lars Penne, MD, PhD Department of Nephrology VU University Medical Center Boelelaan 1117, NL–1081 HV Amsterdam (The Netherlands) Tel. +31 20 444 307, Fax +31 20 444 313, E-Mail el.penne @ vumc.nl © 2011 S. Karger AG, Basel 0253–5068/11/0313–0086$38.00/0 Accessible online at: www.karger.com/bpu D ow nl oa de d by : 54 .1 91 .4 0. 80 9 /1 6/ 20 17 8 :3 5: 14 P M Sodium Gradient: A Tool to Individualize Dialysate Sodium Prescription Blood Purif 2011;31:86–91 87 the dialysate and the predialysis serum sodium concentration [7] . The serum sodium concentration is generally stable over time in hemodialysis patients [3, 8] . If the dialysate sodium concentration is higher than the predialysis serum sodium (i.e. a positive gradient), there is a diffusive flux of sodium over the membrane from the dialysate to the blood compartment, which will attenuate the total intradialytic sodium removal and may cause net sodium loading. Conversely, a dialysate sodium concentration lower than the predialysis serum sodium (i.e. a negative gradient) is characterized by diffusive transport of sodium from the blood to the dialysate and contributes to sodium removal and possible deficiency. Sodium gradient is a potentially useful tool to individualize the dialysate sodium prescription [9] . In the present article, the relation between sodium gradient and shortand long-term clinical outcomes is reviewed and recommendations are provided on how the dialysate sodium prescription could be adjusted based on the sodium gradient. Sodium Gradient, Intradialytic Weight Gain and
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Sodium Gradient: A Tool to Individualize Dialysate Sodium Prescription in Chronic Hemodialysis Patients?
Low dialysate sodium concentrations have been associated with intradialytic symptoms such as muscle cramps and hypotensive episodes. High dialysate sodium concentrations lead to sodium loading, thirst and subsequent increase in interdialytic weight gain and hypertension. The optimal dialysate sodium concentration for an individual depends on the serum sodium concentration. The difference betwee...
متن کاملSodium gradient: a tool to individualize dialysate sodium prescription in chronic hemodialysis patients?
Low dialysate sodium concentrations have been associated with intradialytic symptoms such as muscle cramps and hypotensive episodes. High dialysate sodium concentrations lead to sodium loading, thirst and subsequent increase in interdialytic weight gain and hypertension. The optimal dialysate sodium concentration for an individual depends on the serum sodium concentration. The difference betwee...
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Hypertension and chronic volume overload are complications often seen in hemodialysis patients. Current hemodialysis practices adopt a standard dialysate sodium prescription that is typically higher than the plasma sodium concentration of most patients. As a general rule, hemodialysis patients have stable predialysis plasma sodium concentrations, and each patient has a fixed "osmolar set point....
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BACKGROUND Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate...
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BACKGROUND A higher sodium gradient (dialysate sodium minus pre-dialysis plasma sodium) during hemodialysis (HD) has been associated with sodium loading; however, its role is not well studied. We hypothesized that a sodium dialysate prescription resulting in a higher sodium gradient is associated with increases in interdialytic weight gain (IDWG), blood pressure (BP) and thirst. METHODS We co...
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