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Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension.
Nephrol Dial Transplant. 2006 Nov; 21(11):3231-7.ND

Abstract

BACKGROUND

Symptomatic hypotension is the most frequent complication in patients receiving haemodialysis (HD). Previous studies have reported that the use of modulating dialysate sodium concentration or ultrafiltration (UF) rates, or the combination use of sodium profile and UF profile may better preserve blood volume and reduce the incidence of hypotensive episodes. The aim of this study was to evaluate the effects of sodium balance-neutral sodium profile and UF profile and their combination on preservation of blood volume, cardiac function and occurrence of hypotensive episodes.

METHODS

Using Fresenius MC 4008S, eight stable HD patients underwent four treatments: (1) control, constant dialysate sodium concentration of 138 mmol/l with constant UF; (2) sodium profile, a linearly decreasing dialysate sodium concentration (148-131 mmol/l) with constant UF; (3) UF profile, a linearly decreasing UF rate with dialysate sodium concentration of 138 mmol/l; (4) sodium+UF profile, combination of sodium and UF profile. Each treatment was applied in 10 dialysis sessions. Relative blood volume (RBV), mean blood pressure (MBP), heart rate (HR), interior vena cava diameter (IVCD), stroke volume (SV), cardiac output (CO), plasma sodium concentration and the frequency of symptomatic hypotension were monitored.

RESULTS

There were no significant differences in the IVCD, MBP, SV, CO and body weight before dialysis between the three profiles and the control. The total plasma protein, haemoglobin, and intradialytic sodium mass removal showed similar results. Compared with the control, better preservation of RBV and MBP at 4 and 5 h and a higher stability in SV variation, but larger UF volume were achieved during sodium+UF profile (P<0.05, respectively), the incidence of intradialytic hypotension was significantly reduced (P<0.05).

CONCLUSIONS

With the similar intradialytic sodium removal, during sodium balance-neutral linearly decreasing sodium profile combined with linearly decreasing UF profile, greater intradialytic stability of the blood volume, blood pressure and cardiac function could be obtained, and hypotensive episodes were significantly reduced.

Authors+Show Affiliations

Division of Nephrology, FuXing Hospital, Capital University of Medical Science, #20 Fuxingmenwai Street, Beijing 100038, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16954178

Citation

Zhou, Yi Lun, et al. "Impact of Sodium and Ultrafiltration Profiling On Haemodialysis-related Hypotension." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 21, no. 11, 2006, pp. 3231-7.
Zhou YL, Liu HL, Duan XF, et al. Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension. Nephrol Dial Transplant. 2006;21(11):3231-7.
Zhou, Y. L., Liu, H. L., Duan, X. F., Yao, Y., Sun, Y., & Liu, Q. (2006). Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 21(11), 3231-7.
Zhou YL, et al. Impact of Sodium and Ultrafiltration Profiling On Haemodialysis-related Hypotension. Nephrol Dial Transplant. 2006;21(11):3231-7. PubMed PMID: 16954178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension. AU - Zhou,Yi Lun, AU - Liu,Hui Lan, AU - Duan,Xiao Feng, AU - Yao,Ying, AU - Sun,Yi, AU - Liu,Qun, Y1 - 2006/09/05/ PY - 2006/9/7/pubmed PY - 2007/1/31/medline PY - 2006/9/7/entrez SP - 3231 EP - 7 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 21 IS - 11 N2 - BACKGROUND: Symptomatic hypotension is the most frequent complication in patients receiving haemodialysis (HD). Previous studies have reported that the use of modulating dialysate sodium concentration or ultrafiltration (UF) rates, or the combination use of sodium profile and UF profile may better preserve blood volume and reduce the incidence of hypotensive episodes. The aim of this study was to evaluate the effects of sodium balance-neutral sodium profile and UF profile and their combination on preservation of blood volume, cardiac function and occurrence of hypotensive episodes. METHODS: Using Fresenius MC 4008S, eight stable HD patients underwent four treatments: (1) control, constant dialysate sodium concentration of 138 mmol/l with constant UF; (2) sodium profile, a linearly decreasing dialysate sodium concentration (148-131 mmol/l) with constant UF; (3) UF profile, a linearly decreasing UF rate with dialysate sodium concentration of 138 mmol/l; (4) sodium+UF profile, combination of sodium and UF profile. Each treatment was applied in 10 dialysis sessions. Relative blood volume (RBV), mean blood pressure (MBP), heart rate (HR), interior vena cava diameter (IVCD), stroke volume (SV), cardiac output (CO), plasma sodium concentration and the frequency of symptomatic hypotension were monitored. RESULTS: There were no significant differences in the IVCD, MBP, SV, CO and body weight before dialysis between the three profiles and the control. The total plasma protein, haemoglobin, and intradialytic sodium mass removal showed similar results. Compared with the control, better preservation of RBV and MBP at 4 and 5 h and a higher stability in SV variation, but larger UF volume were achieved during sodium+UF profile (P<0.05, respectively), the incidence of intradialytic hypotension was significantly reduced (P<0.05). CONCLUSIONS: With the similar intradialytic sodium removal, during sodium balance-neutral linearly decreasing sodium profile combined with linearly decreasing UF profile, greater intradialytic stability of the blood volume, blood pressure and cardiac function could be obtained, and hypotensive episodes were significantly reduced. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/16954178/Impact_of_sodium_and_ultrafiltration_profiling_on_haemodialysis_related_hypotension_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfl375 DB - PRIME DP - Unbound Medicine ER -