Journal Article

Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration

Karin Moret, Daxenos Hassell, Jeroen P. Kooman, Frank van der Sande, Paul G. G. Gerlag, A. Warmold L. van den Wall Bake, Jarno van de Bogaart and Karel M. L. Leunissen

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 17, issue 8, pages 1463-1469
Published in print August 2002 | ISSN: 0931-0509
Published online August 2002 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/17.8.1463
Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration

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Background. Although a higher dialysate sodium concentration (DNa) is frequently used to improve haemodynamic stability during haemodialysis, few studies have compared ionic mass balance (IMB) during different DNa. Moreover, DNa is usually a standard prescription, whereas inter‐individual pre‐dialytic serum sodium levels may differ widely. The aims of the study were to assess IMB and the decline in blood volume (ΔBV) during isovolaemic HD as well as during HD combined with ultrafiltration (UF) during DNa [140], DNa [144], and an individualized DNa [ind], in which DNa is equal to pre‐HD plasma conductivity×10.

Methods. IMB and plasma conductivity were assessed by on‐line conductivity measurements (Diascan®; Hospal®) in 13 HD patients. After 1 h of isovolaemic HD, measurements were continued during UF+HD until dry weight. ΔBV was assessed by an optical method (Hemoscan®).

Results. During isovolaemic HD with DNa [140] and [144], Pre‐Na was significantly related to IMB (r=0.83 and r=0.61; P<0.05). Diffusive Na flux into the patient occurred when the difference between DNa and pre‐dialytic serum sodium was larger than 5 mmol/l. During UF+HD, IMB was 318±166 mmol during DNa [140], 277±116 mmol during DNa [ind], and 239±111 during DNa [144] (mean±SD; P<0.05 compared with the other treatment modalities) whereas ΔBV did not differ significantly. In the five patients with a pre‐dialytic sodium concentration below 140 mmol/l, ionic removal was significantly higher during DNa [ind] (324±87) compared with DNa [140] (228±127 mmol; P<0.05) without a significant difference in ΔBV (−9.7±1.6 vs −7.8±2.3%).

Conclusion. A large difference in IMB was observed between DNa 144 and DNa 140, without a significant difference in ΔBV. In patients with low pre‐dialytic serum sodium levels, diffusive ionic influx from the dialysate into the patient may occur. In patients with low pre‐dialytic sodium levels, DNa [ind] leads to an enhanced ionic removal compared with DNa [140] without large differences in ΔBV.

Keywords: blood volume; dialysate sodium concentration; ionic mass balance; haemodialysis; ultrafiltration

Journal Article.  3891 words.  Illustrated.

Subjects: Nephrology

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