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The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients.
Nephrol Dial Transplant. 2006 Jan; 21(1):138-44.ND

Abstract

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.

Authors+Show Affiliations

Department of Internal Medicine, Maxima Medical Centre, Veldhoven and University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16144849

Citation

Moret, Karin, et al. "The Effect of Sodium Profiling and Feedback Technologies On Plasma Conductivity and Ionic Mass Balance: a Study in Hypotension-prone Dialysis Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 21, no. 1, 2006, pp. 138-44.
Moret K, Aalten J, van den Wall Bake W, et al. The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. Nephrol Dial Transplant. 2006;21(1):138-44.
Moret, K., Aalten, J., van den Wall Bake, W., Gerlag, P., Beerenhout, C., van der Sande, F., Leunissen, K., & Kooman, J. (2006). The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 21(1), 138-44.
Moret K, et al. The Effect of Sodium Profiling and Feedback Technologies On Plasma Conductivity and Ionic Mass Balance: a Study in Hypotension-prone Dialysis Patients. Nephrol Dial Transplant. 2006;21(1):138-44. PubMed PMID: 16144849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. AU - Moret,Karin, AU - Aalten,Jeroen, AU - van den Wall Bake,Warmold, AU - Gerlag,Paul, AU - Beerenhout,Charles, AU - van der Sande,Frank, AU - Leunissen,Karel, AU - Kooman,Jeroen, Y1 - 2005/09/06/ PY - 2005/9/8/pubmed PY - 2006/3/1/medline PY - 2005/9/8/entrez SP - 138 EP - 44 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 21 IS - 1 N2 - 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. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/16144849/The_effect_of_sodium_profiling_and_feedback_technologies_on_plasma_conductivity_and_ionic_mass_balance:_a_study_in_hypotension_prone_dialysis_patients_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfi118 DB - PRIME DP - Unbound Medicine ER -