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NDT Advance Access originally published online on September 6, 2005
Nephrology Dialysis Transplantation 2006 21(1):138-144; doi:10.1093/ndt/gfi118
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Original Articles: Dialysis and Transplantation

The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients

Karin Moret1, Jeroen Aalten1, Warmold van den Wall Bake1, Paul Gerlag1, Charles Beerenhout1, Frank van der Sande2, Karel Leunissen2 and Jeroen Kooman2

1 Department of Internal Medicine, Maxima Medical Centre, Veldhoven and 2 University Hospital Maastricht, The Netherlands

Correspondence and offprint requests to: Jeroen Kooman, Department of Internal Medicine, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: jkoo{at}sint.azm.nl



   Abstract
Top
 Abstract
Introduction
 Subjects and methods
 Results
 Discussion
 References
 
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.

Keywords: Hypertension; plasma conductivity; sodium profiling



   Introduction
Top
 Abstract
 Introduction
Subjects and methods
 Results
 Discussion
 References
 
Sodium profiling with a high dialysate sodium concentration is an effective method for the prevention of intra-dialytic hypotension, but also has possible drawbacks such as increased thirst, inter-dialytic weight gain and hypertension [1,2].

Recently, it has become possible to model the decline in blood volume and changes in plasma conductivity (PC), as a surrogate of plasma sodium, by means of feedback technologies. With blood volume (BV)-controlled feedback technologies, a target for a maximal decline in BV is set, which is achieved by continuous adjustments of ultrafiltration rate and (when using the Hemocontrol© module) continuous adjustments of dialysate conductivity in response to measured changes in BV [2]. In the case of PC-controlled feedback, a target for end-dialytic PC is set, and achieved by frequent adjustments of dialysate conductivity during the dialysis sessions, in response to on-line measured changes in PC [3–5]. With both BV- and PC-controlled feedback, it is possible to achieve these targets with a high level of precision. Both modalities are theoretically appealing and were shown to be successful in clinical studies [3–10], although clinical experience with conductivity-controlled feedback in particular is still limited [5,10]. Both modalities, however, also have potential caveats. From a theoretical point of view, the frequent adjustments of dialysate conductivity (DC) during BV-controlled feedback may lead to alterations in sodium removal compared to standard dialysis sessions. PC-controlled feedback treatments with generalized pre-set targets (such as a post-dialytic PC of 14.0 mS/cm) may lead to reduced sodium removal in those patients with low pre-dialytic plasma sodium levels. Little data on sodium balance during these different manoeuvres are available in the literature and are, in most cases, based on a limited number of measurements during the study period [6–9]. By means of assessment of ionic mass balance (IMB) and changes in pre-dialytic PC, it is possible to assess sodium balance during dialysis therapy in a non-invasive way during every dialysis treatment [3,4,11]. However, although IMB was able to detect differences in sodium transfer during a single treatment session [11], its value in assessing chronic changes in sodium balance is not well established.

The aim of the present study was to compare the effects of standard dialysis, a sodium with a mean dialysate sodium concentration, and PC- and BV-controlled feedback treatments on PC and IMB, as surrogate parameters for sodium balance.



   Subjects and methods
Top
 Abstract
 Introduction
 Subjects and methods
Results
 Discussion
 References
 
12 patients with frequent symptomatic (see definition below) or asymptomatic hypotensive episodes (decline in systolic blood pressure below 100 mmHg) during dialysis (i.e. >2 during 3 weeks before the start of the study) were included in the study. One patient withdrew from the study because of mitral valve surgery, and one patient died from a cardiac arrest. Data from these patients were excluded from the analysis. All patients had a residual glomerular filtration rate <2 ml/min. The origin of renal failure in the 10 patients who completed the study was diabetes mellitus (n = 4), cholesterol emboli (n = 1), chronic glomerulonephritis (n = 3), hypertensive nephrosclerosis (n = 1) and chronic interstitial nephritis (n = 1). Other characteristics of the patients who completed the study are shown in Table 1. The study was approved by the Ethics committee of the Maxima Medical Centre. All patients gave written informed consent.


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  		Table 1. Patient characteristics

 
Design
All patients were treated with standard HD treatment (DC 140 mmol/l), a linear decreasing sodium profile (DC 15.0->14.0 mmol/l), BV-controlled feedback (mean DC 14.0 mS/cm) and PC-controlled feedback (target: post-dialytic PC 14.0 mS/cm).

The treatment order was prescribed en blocs using a four-treatments, four-period randomized cross-over design. Patients were randomized into one of the following treatment blocks: I, standard dialysis-sodium profile–BV-controlled feedback–PC-controlled feedback; II, sodium profile–BV-controlled feedback–PC-controlled feedback–standard dialysis; III, BV-controlled feedback–PC-controlled feedback–standard dialysis–sodium profile; or IV, BV-controlled feedback–PC-controlled feedback–standard dialysis-sodium profile.

During each block, patients received 11 consecutive treatments of this modality, followed by 1 week's treatment with standard dialysis in order to prevent possible carry-over effects, after which 11 treatments with the following modality were started, etc. Total duration of the study was 4 months.

Dialysis schedule
The dialysis schedule of the patients was 3 times weekly in all patients. Dialysis time is mentioned in Table 1. Polysulfone (F8HPS; Fresenius®) low flux dialysis membranes were used. Composition of the dialysate was: potassium 2.0 mmol/l, calcium 1.5 mmol/l, magnesium 0.5 mmol/l, bicarbonate 32 mmol/l, acetate 3.0 mmol/l and glucose 1 g/l. Temperature of the dialysate was 36°C. Patients were ultrafiltered until their clinically determined dry weight.

Ionic mass balance
IMB was estimated by Diascan® (Hospal-Gambro®, Lyon, France) [4,11,12]. In short, Diascan® measures IMB by constant measurement of the conductivity in the dialysis outlet and inlet according to the formula IMB = [(Qdin x Cdin)(Qdout x Cdout)] x 10 x time (min). Qdout and Qdin are dialysate flow at, respectively, outlet and inlet; Cdout and Cdin are dialysate conductivity at, respectively, outlet and inlet. A positive IMB reflects net sodium removal from the patient, a negative IMB means net sodium transfer from dialysate to the patient.

Plasma conductivity
PC was measured by Diascan® by measuring dialysance (D) in combination with measurements of Cdout and Cdin according to the formula. PC = [Cdout – (1 – D/Qd) x Cdin]/(D/Qd). D is assessed every 30 min by measuring the increase in Cdout after a temporary increase in Cdin by 1 mS/cm according to the formula D = Qd x [1 – (Cdout2 – Cdout1)/(Cdin2 – Cdin1)]. 1 and 2 indicate, respectively, the measurements before and after the temporary increase in Cdin [4,11,12].

Relative blood volume
BV was measured continuously by continuous optical assessment of changes in haemoglobin during the dialysis session (Haemoscan®; Hospal-Gambro) [13].

Description of the feedback modules
BV-controlled feedback (Hemocontrol®; Hospal-Gambro), described in detail elsewhere [6], is achieved with a closed-loop automatic control system using three controlled variables and two control variables. The three controlled variables are total weight loss (TWL), BV change, and equivalent conductivity, a value derived from the DC which is defined as the conductivity value required to achieve the same sodium mass balance compared to standard HD [6]. The control variables consist of the set ultrafiltration rate (UFR) and the delivered DC. Discrepancies between ideal and achieved controlled variable values are processed by a multi-input/multi-output controller that in turn effectuates a response through the two actuators, the control variables UFR and DC. Changes in BV are determined by Hemoscan® (see above). TWL is measured volumetrically.

Before the start of the study, the patient underwent 10 regular treatments. During this period, the mean BV change at which hypotension occurred was recorded. The target BV:TWL ratio during BV-controlled feedback was 20% higher than this value.

With PC-controlled feedback (Diacontrol®; Hospal-Gambro), PC is modelled automatically during dialysis by adjustment of DC using single-pool kinetic modelling [4,5]. PC is measured throughout the HD session by Diascan® as described above. The target post-dialytic PC was 14.0 mS/cm during all treatment sessions.

Serum sodium
Serum sodium was assessed by indirect ionometry (Vitros 950®), which assesses sodium activity in the serum. Sodium activity is automatically converted to the molar ionized sodium concentration. Obtained values were corrected by converting the molar concentration to flame photometer values by a standard correction factor (0.93) [10]. The coefficient of variation for this method, as given by the manufacturer, is 0.4%.

Blood pressure measurements
Blood pressure was assessed every 30 min with an oscillometric device (HDBPM 4; Hospal-Gambro). Also during each symptomatic event, blood pressure was measured.

Definition of intra-dialytic hypotension
Symptomatic hypotension was defined as a decline in systolic blood pressure to <100 mmHg (in patients with pre-dialytic systolic blood pressure to <110 mmHg), or a decline in systolic blood pressure larger than 30 mmHg together with typical symptoms, necessitating nursing interventions. Also all intra-dialytic morbid events (cramps, nausea, headache, abdominal pain, with or without hypotension) were recorded. Also all episodes with a decline in systolic pressure below 100 mmHg were recorded.

Power analysis
Primary outcome parameter was the difference in pre-dialytic PC between the various modalities. Assuming an SD of 0.2 mS/cm [11], eight patients would be needed to show a mean difference of 0.2 mS/cm between two different treatment modalities with a level below 0.05 and a power of 0.80. Assuming an SD of 110 mmol for IMB [11], nine patients had to be included in order to show a difference of 100 mmol with the same significance levels. In order to correct for multiple comparisons and drop-outs, 12 patients were included.

Statistics
Repeated measurements ANOVA was used to compare the different parameters between the various modalities. The mean value of the 11 treatments for each modality was entered into the analysis. To assess the determinants of IMB, multiregression analysis was used. Fisher's exact-test was used to assess differences in frequency of hypotension between the different modalities. P-values <0.05 were considered significant. The SPSS 12.0 package was used for statistical analysis.



   Results
Top
 Abstract
 Introduction
 Subjects and methods
 Results
Discussion
 References
 
Data for IMB and PC were available for all sessions. In total, data for 440 sessions were analysed.

Plasma conductivity
Mean pre- and post-dialytic PC were increased during the sodium profile compared to standard HD. Pre-dialytic PC did not differ between BV- and PC-controlled feedback compared to standard HD (Figure 1 and Table 2). Post-dialytic PC was significantly lower during PC-controlled feedback compared to the other manoeuvres.



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  		Fig. 1. Pre- and post-dialytic PC levels during the different modalities. Covered boxes indicate 25–75% with median value; captured bars indicate the range of data. Dots indicate outliers. Both pre- and post-dialytic PC were significantly lower during the sodium profile compared to all other treatments (P<0.05). Post-dialytic PC was significantly lower during PC-controlled feedback compared to the other manoeuvres.

 

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  		Table 2.
 
PC-controlled feedback was able to reach target post-dialytic PC levels within narrow limits (14.03±0.03 mS/cm). In those sessions in which pre-dialytic plasma conductivity levels were <14.0 mS/cm, as expected, PC increased significantly (+0.21±0.17; P<0.001) and declined during sessions when pre-dialytic PC was >14.0 mS/cm (–0.18±0.14; P<0.001). During PC-controlled feedback, the intra-individual coefficient of variation of pre-dialytic PC levels was 1.3%. Pre-dialytic PC varied between values above and below 14.0 mS/cm in six of the patients during the period with PC-controlled feedback.

Single measurements of pre-dialytic plasma sodium did not differ between the different modalities: 138±2 mmol/l during standard dialysis, 137±2 mmol/l during BV-controlled feedback, 139±3 mmol/l during the sodium profile and 138±3 mmol/l during PC conductivity-controlled feedback.

Ionic mass balance
IMB during the first session was lowest during the sodium profile (315±157 mmol; P<0.05). Between the other manoeuvres, IMB during the first sessions did not differ: 423±166 mmol during standard dialysis, 488±179 mmol during BV-controlled feedback and 409±109 mmol during PC-controlled feedback.

During the remainder of the sessions, IMB did not differ significantly between the different treatment modalities (Table 2).

However, during PC-controlled feedback, IMB was lower during the sessions when pre-dialytic PC was lower than 14.0 mS/cm (n = 30) compared to sessions before which pre-dialytic PC was higher than 14.0 mS/cm (n = 80). (248±98 vs 416±174 mmol/l; P<0.001) despite comparable ultrafiltration volume (2.0±0.7 vs 2.0±1.1 kg).

Pooling all treatments, ionic mass removal was highly dependent upon both ultrafiltration volume (ß = 0.72; P<0.001) and the difference between pre-dialytic plasma conductivity and dialysate conductivity (ß = 0.72; P<0.001) (Figure 2), but not on the treatment modality.



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  		Fig. 2. Relation between ionic mass balance and pre-dialytic and dialysate conductivity. (r2 = –0.46; P<0.001).

 
Inter-dialytic weight gain and blood pressure and blood volume
Neither inter-dialytic weight gain nor pre-dialytic blood pressure differed significantly between the various treatment modalities (Table 2). Also post-dialytic blood pressure and the maximal decline in blood pressure were not significantly different between the various treatment modalities. The decline in BV was comparable between the various treatment modalities (Table 2).

Intra-dialytic hypotension
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. The same held true for the total number of symptoms during dialysis (with or without hypotension): BV-controlled feedback, n = 22; standard HD, n = 31; sodium profile, n = 29; PC-controlled feedback, n = 32 (P = NS). The total number of sessions during which systolic BP declined to <100 mmHg did not differ significantly between the different manoeuvres: BV-controlled feedback, 26%; standard HD, 35%; sodium profile, 28%; PC-controlled feedback, 26% (P = NS).

The peak systolic blood pressure did not differ between the various sessions (Table 2).



   Discussion
Top
 Abstract
 Introduction
 Subjects and methods
 Results
 Discussion
References
 
In this randomized crossover study, we assessed the effect of a sodium profile and different feedback technologies on PC, IMB and haemodynamic tolerance. A significant increase in pre-dialytic PC was observed during the sodium profile, but not during BV-controlled feedback, whereas pre-dialytic PC was not different during PC-controlled feedback compared to standard HD.

IMB was lowest during the sodium profile, but only during the first session, and not during the remainder of the dialysis sessions with the sodium profile. IMB during the other modalities was comparable. The increase in pre- and post-dialytic PC, as surrogate markers of plasma sodium, is in agreement with various, but not all, earlier studies towards the effect of profiles with high mean sodium concentrations [1,2].

The effects of BV-controlled feedback on PC and IMB did not differ from standard dialysis. Data on the effects of BV-controlled feedback on sodium homeostasis are scarce, although earlier studies did not show a difference in plasma sodium levels compared to standard HD sessions. However, in these studies, serum sodium was only measured a few times during the study period, whereas in the present study, PC was assessed during all treatment sessions.

With PC-controlled feedback, mean pre-dialytic PC was not different compared to standard dialysis. However, mean post-dialytic PC was significantly lower compared to standard HD. The target post-dialytic PC was 14.0 mS/cm in the present study. In agreement with earlier data from Locatelli et al. [10], PC-controlled feedback was able to achieve this target within very narrow limits. However, caution should be applied with the use of PC-controlled feedback with generalized preset targets in patients with low pre-dialytic PC levels. An interesting but somewhat cumbersome approach given the intra-individual variation of predialytic PC or sodium levels may be the use of individualized targets for dialysate sodium or post-dialytic PC [10,11,14].

IMB was only significantly different between the first sessions of the different modalities, and not during the remaining sessions. This can be explained by the fact that, next to ultrafiltration volume, IMB is determined by the ratio between predialytic PC and dialysate conductivity [11]. Thus, as pre-dialytic PC increased during the sodium profile, the difference between PC and DC remained comparable to the other modalities, resulting in equal IMB. Therefore, the absence of differences in IMB between different dialysis modalities in a steady state does not imply that these do not differ in their effect on sodium balance. To estimate such an effect, measurement of plasma sodium or PC levels remains necessary.

However, during PC conductivity-controlled feedback, IMB was lower when pre-dialytic PC was <14.0 mS/cm compared with pre-dialytic PC levels >14.0 mS/cm. This is due to the strong relation between pre-dialytic PC and dialysate conductivity. As in the majority of patients, pre-dialytic PC levels varied between values above and below 14.0 mS/cm, IMB may be unpredictable when using generalized pre-set targets, as discussed previously.

Despite differences in pre-dialytic PC, pre-dialytic blood pressure and inter-dialytic weight gain did not differ between the different treatment modalities. However, small effects on inter-dialytic blood pressure may have been missed in the present study, due to the absence of ambulatory blood pressure measurements.

The effect of sodium profiling on inter-dialytic weight gain and inter-dialytic blood pressure control is not consistent between different studies. Whereas some studies found an increase in inter-dialytic weight gain and/or an increase in pre-dialytic systolic or inter-dialytic blood pressure, other studies did not [1,2].

A potential explanation for the absence of a difference in weight gain or blood pressure control between the various modalities may be strict adherence to fluid restriction of our patients. Regrettably, thirst sensation was not quantified in a structured way in the present study.

The incidence of symptomatic intra-dialytic hypotension was lowest during BV-controlled feedback, but differences between the various manoeuvres did not reach significance, due to underpowering of the study for this parameter. Earlier studies with larger number of patients have demonstrated the effect of BV-controlled feedback on intra-dialytic complications [6,7,15–17].

Except for the possible underpowering with respect to the secondary outcome parameter of intra-dialytic hypotension, some other drawbacks should also be mentioned. Firstly, PC and not plasma sodium was assessed in the present study, due to the fact that this parameter can be assessed on-line without need for blood sampling. Previous studies have shown a very close correlation between PC and plasma sodium levels [11,18,19]. However, PC is not equal to plasma sodium and, albeit to a much smaller degree, is also influenced by other electrolytes such as potassium. This might be reflected in the fact that post-dialytic PC was lower than pre-dialytic PC during all different modalities. From a theoretical point of view, differences in potassium and acid base balance are not to be expected between the different dialysis strategies studied in this paper. Indeed, frequent measurements of PC may be more sensitive in observing differences in sodium balance than single measurements of plasma sodium. In the present study, single measurements of plasma sodium did not differ between the various modalities.

Lastly, the sodium profile used in the present study is only an example of many different sodium profiles described in the literature [2]. However, in the majority of effective sodium profiles high dialysate sodium concentrations are used.

Summarizing, pre- and post-dialytic PC, as a surrogate marker of plasma sodium, increased during high-sodium profiling, but not during BV- or PC-controlled feedback treatments. 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. Except for the first treatment, IMB did not differ between the various manoeuvres, due to the equilibration between pre-dialytic PC and DC. Therefore, IMB appears of limited value to assess differences in sodium balance between different manoeuvres in steady state.

Conflict of interest statement. None declared.



   References
Top
 Abstract
 Introduction
 Subjects and methods
 Results
 Discussion
 References
 

  1. Song JH, Park GH, Lee SY, Lee SW, Lee SW, Kim MJ. Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances. J Am Soc Nephrol 2005; 16: 237–246[Abstract/Free Full Text]
  2. Mann H, Stiller S. Sodium modeling. Kidney Int Suppl 2000; 76: S79–S88[Medline]
  3. Locatelli F, Di Filippo S, Manzoni C. Relevance of the conductivity kinetic model in the control of sodium pool. Kidney Int Suppl 2000; 76: S89–S95[Medline]
  4. Bosetto A, Bene B, Petitclerc T. Sodium management in dialysis by conductivity. Adv Ren Replace Ther 1999; 6: 243–254[Web of Science][Medline]
  5. Di Giulio S, Meschini L, Friggi A et al. Sodium transport with different dialysis ultrafiltration schedules using a bio-feedback module (BFB). Nephrol Dial Transplant 1998; 13 [Suppl 6]: 39–42
  6. Santoro A, Mancini E, Paolini F, Cavicchioli G, Bosetto A, Zucchelli P. Blood volume regulation during hemodialysis. Am J Kidney Dis 1998, 32: 739–748[Web of Science][Medline]
  7. Wolkotte C, Hassell DR, Moret K et al. Blood volume control by biofeedback and dialysis-induced symptomatology. A short-term clinical study. Nephron 2002; 92: 605–609[CrossRef][Medline]
  8. Basile C, Giordano R, Vernaglione L et al. Efficacy and safety of haemodialysis treatment with the Hemocontrol biofeedback system: a prospective medium-term study. Nephrol Dial Transpl 2001; 16: 328–334[Abstract/Free Full Text]
  9. Santoro A, Mancini E, Basile C et al. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int 2002; 62: 1034–1045[CrossRef][Web of Science][Medline]
  10. Locatelli F, Andrulli S, Di Filippo S et al. Effect of on-line conductivity plasma ultrafiltrate kinetic modeling on cardiovascular stability of hemodialysis patients. Kidney Int 1998; 53: 1052–1060[Medline]
  11. Moret K, Hassell D, Kooman JP et al. Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration. Nephrol Dial Transplant 2002; 17: 1463–1469[Abstract/Free Full Text]
  12. Petitclerc T, Bene B, Goux N, Saudon MC, Jacobs C. Non invasive monitoring of effective dialysis dose delivered to the hemodialysis patient. Nephrol Dial Transplant 1995; 10: 212–216[Abstract/Free Full Text]
  13. Paolini F, Mancini E, Bosetto A, Santoro A. Hemoscan: a dialysis machine-integrated blood volume monitor. Int J Artif Organs 1995; 18: 487–494[Medline]
  14. de Paula FM, Peixoto AJ, Pinto LV, Dorigo D, Patricio PJ, Santos SF. Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int 2004; 66: 1232–1238[CrossRef][Web of Science][Medline]
  15. Ronco C, Brendolan A, Milan M, Rodeghiero MP, Zanella M, La Greca G. Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Kidney Int 2000; 58: 800–808[CrossRef][Web of Science][Medline]
  16. Oliver MJ, Edwards LJ, Churchill DN. Impact of sodium and ultrafiltration profiling on hemodialysis-related symptoms. J Am Soc Nephrol 2001; 12: 151–156[Abstract/Free Full Text]
  17. Dheenan S, Henrich WL. Preventing dialysis hypotension: a comparison of usual protective manoeuvers. Kidney Int 2001; 59: 1175–1181[CrossRef][Web of Science][Medline]
  18. Locatelli F, Di Filippo S, Manzoni C, Corti M, Andrulli S, Pontoriero G. Monitoring sodium removal and delivered dialysis by conductivity. Int J Artif Organs 1995; 18: 716–721[Web of Science][Medline]
  19. Goureau Y, Petitclerc T, Man NK. Evaluation of plasma sodium concentration during hemodialysis by computerization of dialysate conductivity. ASAIO Trans 1990; 36: M444–M447[Medline]
  20. Petitclerc T. Estimation of mass transfer through a hemodialyzer: theoretical approach and clinical applications. Artif Organs 1998; 22: 601–607[Medline]
Received for publication: 25. 5.05
Accepted in revised form: 11. 8.05


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H. Thein, I. Haloob, and M. R. Marshall
Associations of a facility level decrease in dialysate sodium concentration with blood pressure and interdialytic weight gain
Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2630 - 2639.
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