Nephrol Dial Transplant (2002) 17: 1463-1469
© 2002 European Renal Association-European Dialysis and Transplant Association
Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration
St Joseph Hospital, Veldhoven and 1 University Hospital, Maastricht, The Netherlands
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 (
BV) 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 conductivityx10.
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. BV 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 BV 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 BV (-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 BV. 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 BV.
Keywords: blood volume; dialysate sodium concentration; ionic mass balance; haemodialysis; ultrafiltration
Correspondence and offprint requests to: Jeroen P. Kooman, MD PhD, Department of Internal Medicine, University Hospital Maastricht, PO Box 5800, NL-6202 AZ Maastricht, The Netherlands. Email: jkoo{at}sint.azm
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