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Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system.
Am J Kidney Dis. 2010 Jul; 56(1):69-76.AJ

Abstract

BACKGROUND

Extracellular fluid expansion is common in hemodialysis patients. Aggressive fluid removal may lead to intradialytic complications. High dialysate sodium concentrations may lessen complications, but may increase extracellular volume. We hypothesized that decreasing plasma sodium concentration during dialysis will increase sodium removal and decrease extracellular volume.

STUDY DESIGN

Pilot clinical trial.

SETTING & PARTICIPANTS

16 patients with end-stage kidney disease treated using thrice-weekly hemodialysis at a university teaching hospital hemodialysis unit.

INTERVENTION

Stepwise decrease in postdialysis plasma sodium level (calculated as end-of-session plasma conductivity) over 4 phases effected by dialysate conductivity measurement cells and a biofeedback software system (Diacontrol; Hospal, www.hospal.it) that allowed alteration of dialysate inlet conductivity and calculation of plasma conductivity.

OUTCOMES

Decrease in postdialysis plasma sodium (conductivity) levels, sodium removal, redistribution of body water, and effect of these on interdialytic weight gain and blood pressure.

MEASUREMENTS

Plasma sodium and conductivity values (the latter measured in millisiemens per centimeter); ionic mass balance (sodium removal); bioelectrical impedance analysis measurements of body-water compartments and phase angle; interdialytic weight gain; and blood pressure.

RESULTS

Plasma sodium concentrations at the end of dialysis were decreased from 137.8 (phase 1) to 135.6 mmol/L (phase 4) and end-of-session plasma conductivity values were decreased from 14.0 (phase 1) to 13.5 mS/cm (phase 4; all mean values). Ionic mass balance increased from 383 to 480 mmol. Extracellular water was significantly decreased, phase angle was increased, and blood pressure and interdialytic weight gain were decreased. Plasma sodium levels correlated significantly with plasma conductivity; thus, changes in postdialysis plasma sodium levels can be inferred from changes in end-of-session plasma conductivity values.

LIMITATIONS

Small number of patients. No information for dietary sodium intake.

CONCLUSION

To decrease extracellular volume, it may be necessary to add diffusive to convective sodium losses.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, London Health Sciences Centre, and The University of Western Ontario, London, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20303632

Citation

Manlucu, Jaimi, et al. "Lowering Postdialysis Plasma Sodium (conductivity) to Increase Sodium Removal in Volume-expanded Hemodialysis Patients: a Pilot Study Using a Biofeedback Software System." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 56, no. 1, 2010, pp. 69-76.
Manlucu J, Gallo K, Heidenheim PA, et al. Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system. Am J Kidney Dis. 2010;56(1):69-76.
Manlucu, J., Gallo, K., Heidenheim, P. A., & Lindsay, R. M. (2010). Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 56(1), 69-76. https://doi.org/10.1053/j.ajkd.2009.12.037
Manlucu J, et al. Lowering Postdialysis Plasma Sodium (conductivity) to Increase Sodium Removal in Volume-expanded Hemodialysis Patients: a Pilot Study Using a Biofeedback Software System. Am J Kidney Dis. 2010;56(1):69-76. PubMed PMID: 20303632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system. AU - Manlucu,Jaimi, AU - Gallo,Kerri, AU - Heidenheim,Paul A, AU - Lindsay,Robert M, Y1 - 2010/03/19/ PY - 2009/09/02/received PY - 2009/12/14/accepted PY - 2010/3/23/entrez PY - 2010/3/23/pubmed PY - 2010/7/28/medline SP - 69 EP - 76 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 56 IS - 1 N2 - BACKGROUND: Extracellular fluid expansion is common in hemodialysis patients. Aggressive fluid removal may lead to intradialytic complications. High dialysate sodium concentrations may lessen complications, but may increase extracellular volume. We hypothesized that decreasing plasma sodium concentration during dialysis will increase sodium removal and decrease extracellular volume. STUDY DESIGN: Pilot clinical trial. SETTING & PARTICIPANTS: 16 patients with end-stage kidney disease treated using thrice-weekly hemodialysis at a university teaching hospital hemodialysis unit. INTERVENTION: Stepwise decrease in postdialysis plasma sodium level (calculated as end-of-session plasma conductivity) over 4 phases effected by dialysate conductivity measurement cells and a biofeedback software system (Diacontrol; Hospal, www.hospal.it) that allowed alteration of dialysate inlet conductivity and calculation of plasma conductivity. OUTCOMES: Decrease in postdialysis plasma sodium (conductivity) levels, sodium removal, redistribution of body water, and effect of these on interdialytic weight gain and blood pressure. MEASUREMENTS: Plasma sodium and conductivity values (the latter measured in millisiemens per centimeter); ionic mass balance (sodium removal); bioelectrical impedance analysis measurements of body-water compartments and phase angle; interdialytic weight gain; and blood pressure. RESULTS: Plasma sodium concentrations at the end of dialysis were decreased from 137.8 (phase 1) to 135.6 mmol/L (phase 4) and end-of-session plasma conductivity values were decreased from 14.0 (phase 1) to 13.5 mS/cm (phase 4; all mean values). Ionic mass balance increased from 383 to 480 mmol. Extracellular water was significantly decreased, phase angle was increased, and blood pressure and interdialytic weight gain were decreased. Plasma sodium levels correlated significantly with plasma conductivity; thus, changes in postdialysis plasma sodium levels can be inferred from changes in end-of-session plasma conductivity values. LIMITATIONS: Small number of patients. No information for dietary sodium intake. CONCLUSION: To decrease extracellular volume, it may be necessary to add diffusive to convective sodium losses. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/20303632/Lowering_postdialysis_plasma_sodium__conductivity__to_increase_sodium_removal_in_volume_expanded_hemodialysis_patients:_a_pilot_study_using_a_biofeedback_software_system_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(10)00115-0 DB - PRIME DP - Unbound Medicine ER -