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Dialysate sodium

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https://www.readbyqxmd.com/read/29887269/-the-different-modalities-of-isonatric-hemodialysis
#1
Thierry Petitclerc, François Gaillard
Setting dialysate sodium allows to adequately adjust sodium balance and plasma sodium at the end of dialysis session. In accordance with the set-point theory based on the concept of restoring cellular hydration, an adequate target for plasma sodium at the end of the session could be the value of predialysis plasma sodium concentration (isonatric hemodialysis). Some recently available dialysis monitors provide an on-line value of plasma-water conductivity usually converted in on-line natremia. There are different modalities of isonatric hemodialysis depending on whether the online value of natremia is used or not...
June 7, 2018: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/29844208/mechanisms-of-crystalloid-versus-colloid-osmosis-across-the-peritoneal-membrane
#2
Johann Morelle, Amadou Sow, Charles-André Fustin, Catherine Fillée, Elvia Garcia-Lopez, Bengt Lindholm, Eric Goffin, Fréderic Vandemaele, Bengt Rippe, Carl M Öberg, Olivier Devuyst
Background Osmosis drives transcapillary ultrafiltration and water removal in patients treated with peritoneal dialysis. Crystalloid osmosis, typically induced by glucose, relies on dialysate tonicity and occurs through endothelial aquaporin-1 water channels and interendothelial clefts. In contrast, the mechanisms mediating water flow driven by colloidal agents, such as icodextrin, and combinations of osmotic agents have not been evaluated. Methods We used experimental models of peritoneal dialysis in mouse and biophysical studies combined with mathematical modeling to evaluate the mechanisms of colloid versus crystalloid osmosis across the peritoneal membrane and to investigate the pathways mediating water flow generated by the glucose polymer icodextrin...
May 29, 2018: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29691160/the-frustrating-attempt-to-limit-the-interdialytic-weight-gain-in-patients-on-chronic-hemodialysis-new-insights-into-an-old-problem
#3
REVIEW
Maurizio Bossola, Gilda Pepe, Carlo Vulpio
A significant percentage of patients on chronic hemodialysis have an interdialytic weight gain (IDWG) above the recommended values. High IDWG has detrimental effects on survival, cardiovascular outcomes, and quality of life. High IDWG is secondary to poor adherence to fluid restriction and to excessive intake of fluids, due to thirst and xerostomia. Various strategies have been proposed to limit IDWG such as the reduction of dietary salt intake, behavioral interventions aimed at improving the adherence to fluid restriction, the improvement of xerostomia, and the use of lower dialysate sodium concentration...
April 21, 2018: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/29674410/a-large-intraperitoneal-residual-volume-hampers-adequate-volumetric-assessment-of-osmotic-conductance-to-glucose
#4
Anne-Lorraine Clause, Mehdi Keddar, Ralph Crott, Tom Darius, Catherine Fillée, Eric Goffin, Johann Morelle
BACKGROUND: In end-stage renal disease patients treated with peritoneal dialysis (PD), the osmotic conductance to glucose (OCG) represents the intrinsic ability of the membrane to transport water in response to a crystalloid osmotic gradient. A progressive loss of OCG in long-term PD patients indicates the development of fibrosis in the peritoneal interstitium, and helps identify patients at risk for encapsulating peritoneal sclerosis. The double mini-peritoneal equilibration test (PET) has been proposed as a simple method to assess OCG using the difference in initial ultrafiltration rates generated by 2 successive dwells using 1...
April 19, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/29649799/fallacies-and-pitfalls-of-dialysis-sodium-prescription-and-control
#5
André Stragier, František Lopot, František Švára, Vladimír Polakovič
Dialysate conductivity is routinely used as a surrogate for dialysate sodium concentration. However, dialysis machine manufacturers apply different conductivity temperature correction coefficients. With the same conductivity in dialysis machines manufactured by different manufacturers, dialysate sodium may significantly differ. Also, electrolyte prescriptions are individualized (K, Ca, HCO3) and this is associated with another variation in dialysate sodium in the order of 1-5 mmol/L and both deviations are cumulative and chronic for each patient...
2018: Blood Purification
https://www.readbyqxmd.com/read/29609536/effects-of-dialysate-to-serum-sodium-na-alignment-in-chronic-hemodialysis-hd-patients-retrospective-cohort-study-from-a-quality-improvement-project
#6
Jochen G Raimann, Linda H Ficociello, Len A Usvyat, Hanjie Zhang, Lisa Pacelli, Sandi Moore, Penny Sheppard, Qingqing Xiao, Yuedong Wang, Claudy Mullon, Paul Balter, Terry Sullivan, Peter Kotanko
BACKGROUND: Evidence indicates favorable effects of dialysate (DNa+ ) to serum sodium concentration (SNa+ ) alignment, however, results from larger sample populations are needed. For this reason, we conducted a retrospective propensity score-matched cohort study from a quality improvement project to investigate the effects of alignment on population of maintenance hemodialysis patients. METHODS: At 4 participating hemodialysis (HD) clinics, patients with SNa+ lower than the standard DNa+ of 137 mEq/L who received HD with DNa+ aligned to the average of the last 4 SNa+ measurements were evaluated (clinicaltrials...
April 2, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29594982/penile-calciphylaxis-in-a-patient-on-combined-peritoneal-dialysis-and-hemodialysis
#7
Takahiro Kasai, Naoki Washida, Hirokazu Muraoka, Kentarou Fujii, Kiyotaka Uchiyama, Keisuke Shinozuka, Kohkichi Morimoto, Hirobumi Tokuyama, Shu Wakino, Hiroshi Itoh
Calciphylaxis presents with painful purpura and intractable skin ulcers on the trunk and particularly the distal extremities, and it mainly occurs in patients on chronic dialysis. A 66-year-old man with renal failure due to diabetic nephropathy was on peritoneal dialysis alone for 1 year, followed by peritoneal dialysis combined with hemodialysis for 3 years. He developed calciphylaxis of the penis, which was diagnosed from the skin biopsy findings and clinical observation. To treat this condition, PD was stopped and HD was performed three times a week...
March 28, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29583052/associations-between-dialysate-sodium-concentration-and-plasma-sodium-concentration-of-dogs-receiving-intermittent-hemodialysis-treatments
#8
Jonathan D Foster, Kenneth J Drobatz, Larry D Cowgill
OBJECTIVE To compare dialysate sodium concentration and patient plasma sodium concentration of dogs during intermittent hemodialysis treatments. SAMPLE 211 intermittent hemodialysis treatments performed on 40 client-owned dogs for the management of dialysis-dependent uremia. PROCEDURES Medical records were reviewed to determine the plasma sodium concentration of each dog before and after routine hemodialysis treatments. Associations between detected changes in plasma sodium concentration and dialysate sodium concentration were evaluated by use of Spearman rank correlations and linear regression analysis...
April 2018: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/29482263/why-does-the-choice-of-dialysate-sodium-concentration-remain-controversial
#9
REVIEW
Kamonwan Tangvoraphonkchai, Andrew Davenport
The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration...
February 26, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29467008/interventions-to-prevent-hemodynamic-instability-during-renal-replacement-therapy-in-critically-ill-patients-a-systematic-review
#10
Adrianna Douvris, Gurpreet Malhi, Swapnil Hiremath, Lauralyn McIntyre, Samuel A Silver, Sean M Bagshaw, Ron Wald, Claudio Ronco, Lindsey Sikora, Catherine Weber, Edward G Clark
BACKGROUND: Hemodynamic instability related to renal replacement therapy (HIRRT) may increase the risk of death and limit renal recovery. Studies in end-stage renal disease populations on maintenance hemodialysis suggest that some renal replacement therapy (RRT)-related interventions (e.g., cool dialysate) may reduce the occurrence of HIRRT, but less is known about interventions to prevent HIRRT in critically ill patients receiving RRT for acute kidney injury (AKI). We sought to evaluate the effectiveness of RRT-related interventions for reducing HIRRT in such patients across RRT modalities...
February 22, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29395340/primary-outcomes-of-the-monitoring-in-dialysis-study-indicate-that-clinically-significant-arrhythmias-are-common-in-hemodialysis-patients-and-related-to-dialytic-cycle
#11
Prabir Roy-Chaudhury, Jim A Tumlin, Bruce A Koplan, Alexandru I Costea, Vijay Kher, Don Williamson, Saurabh Pokhariyal, David M Charytan
Sudden death is one of the more frequent causes of death for hemodialysis patients, but the underlying mechanisms, contribution of arrhythmia, and associations with serum chemistries or the dialysis procedure are incompletely understood. To study this, implantable loop recorders were utilized for continuous cardiac rhythm monitoring to detect clinically significant arrhythmias including sustained ventricular tachycardia, bradycardia, asystole, or symptomatic arrhythmias in hemodialysis patients over six months...
April 2018: Kidney International
https://www.readbyqxmd.com/read/29380515/acute-hemodialysis-in-a-young-man-with-severe-symptomatic-hyponatremia-and-kidney-injury
#12
Catherine Courteau, Alex Al Khoury, Rene P Michel, Catherine L Weber
A 35-year-old man presented with severe hypo-osmolar hyponatremia (serum sodium 99 mmol/L), profound nonoliguric renal failure (serum creatinine 1240 μmol/L), and nephrotic range proteinuria. Computed tomography of the abdomen revealed nephromegaly and no obstruction. The patient was admitted to the intensive care unit (ICU) and conventional hemodialysis was initiated. To avoid rapid sodium correction, we prescribed concurrent dialysate flow, a low dialysate sodium concentration, a small surface area dialyzer, and a low blood flow rate...
January 30, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29340313/treatment-of-severe-hyperkalemia-confronting-4-fallacies
#13
REVIEW
J Gary Abuelo
Severe hyperkalemia is a medical emergency that can cause lethal arrhythmias. Successful management requires monitoring of the electrocardiogram and serum potassium concentrations, the prompt institution of therapies that work both synergistically and sequentially, and timely repeat dosing as necessary. It is of concern then that, based on questions about effectiveness and safety, many physicians no longer use 3 key modalities in the treatment of severe hyperkalemia: sodium bicarbonate, sodium polystyrene sulfonate (Kayexalate [Concordia Pharmaceuticals Inc...
January 2018: KI Reports
https://www.readbyqxmd.com/read/29314721/peritoneal-protein-losses-depend-on-more-than-just-peritoneal-dialysis-modality-and-peritoneal-membrane-transporter-status
#14
Suree Yoowannakul, Lauren S Harris, Andrew Davenport
Peritoneal protein clearance (PPCl) depends upon vascular supply and size selective permeability. Some previous reports suggested PPCl can distinguish fast peritoneal membrane transport due to local or systemic inflammation. However, as studies have been discordant, we wished to determine factors associated with an increased PPCl. Consecutive patients starting peritoneal dialysis (PD) who were peritonitis-free were studied. Data included a baseline peritoneal equilibration test (PET), measurement of dialysis adequacy, 24-h dialysate PPCl and body composition measured by multifrequency bioimpedance...
April 2018: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/29210176/online-measurement-of-hemodialysis-adequacy-using-effective-ionic-dialysance-of-sodium-a-review-of-its-principles-applications-benefits-and-risks
#15
REVIEW
Shakil Aslam, Subodh J Saggi, Moro Salifu, Robert J Kossmann
Dialysis dose is an important determinant of clinical outcomes in patients with end stage renal disease on maintenance dialysis. In clinical practice dialysis dose is monitored at least monthly by urea clearance based on Urea Kinetic Modeling. Online clearance monitoring using effective ionic dialysance (EID) of sodium (Na+ ) is available on some hemodialysis machines. This paper reviews the background, methodology, additional applications, and potential risks associated with EID. Effective ionic dialysance provides a reliable, real-time, noninvasive, and inexpensive measurement of dialysis dose during an ongoing hemodialysis (HD) session to allow interventions and assess the impact of these changes on clearance...
December 6, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29166634/sodium-prescription-in-the-prevention-of-intradialytic-hypotension-new-insights-into-an-old-concept
#16
Gabriele Donati, Mauro Ursino, Alessandra Spazzoli, Nicolò Natali, Roberto Schillaci, Diletta Conte, Andrea Angeletti, Anna Laura Croci Chiocchini, Irene Capelli, Olga Baraldi, Gaetano La Manna
BACKGROUND: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist, as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium levels. METHODS: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller. RESULTS: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis (HD) and discusses 2 strategies to remove excess sodium in patients prone to intradialytic hypotension, namely, Profiled HD and the hemodiafiltration Aequilibrium System...
2018: Blood Purification
https://www.readbyqxmd.com/read/29064178/low-dialysate-potassium-concentration-is-associated-with-prolonged-recovery-time
#17
Antonia Harford, Ambreen Gul, Serena Cumber, Susan Paine, Ronald Schrader, Nicole Trujillo, Philip Zager
INTRODUCTION: Modifiable hemodialysis treatment parameters may impact patient reported outcomes, including recovery time. Answers to the recovery question may predict the impact of treatment parameters on clinical outcomes and health related quality of life. However, the reliability of answers to the recovery question after consecutive and nonconsecutive dialysis treatments in diverse populations has not been established. OBJECTIVE: To assess the reliability of this instrument and to determine if recovery time was associated with modifiable dialysis parameters, we conducted a quality assurance project in which we asked, "How long did it take you to recover from your last dialysis session?" after consecutive and nonconsecutive treatments...
October 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28859158/metabolic-inhibition-reduces-cardiac-l-type-ca2-channel-current-due-to-acidification-caused-by-atp-hydrolysis
#18
Giedrius Kanaporis, Rimantas Treinys, Rodolphe Fischmeister, Jonas Jurevičius
Metabolic stress evoked by myocardial ischemia leads to impairment of cardiac excitation and contractility. We studied the mechanisms by which metabolic inhibition affects the activity of L-type Ca2+ channels (LTCCs) in frog ventricular myocytes. Metabolic inhibition induced by the protonophore FCCP (as well as by 2,4- dinitrophenol, sodium azide or antimycin A) resulted in a dose-dependent reduction of LTCC current (ICa,L) which was more pronounced during β-adrenergic stimulation with isoprenaline. ICa,L was still reduced by metabolic inhibition even in the presence of 3 mM intracellular ATP, or when the cell was dialysed with cAMP or ATP-γ-S to induce irreversible thiophosphorylation of LTCCs, indicating that reduction in ICa,L is not due to ATP depletion and/or reduced phosphorylation of the channels...
2017: PloS One
https://www.readbyqxmd.com/read/28794292/cross-linked-polyelectrolyte-and-its-function-in-adsorption-of-fluid-and-excess-nitrogen-waste-products-an-experimental-study-on-dialysate-effluent-fluid
#19
Hamid Tayebi Khosroshahi, Behzad Abedi, Sabalan Daneshvar, Effat Alizadeh, Mohammadreza Khalilzadeh, Yaghoub Abedi
INTRODUCTION: One of the most important issues in patients with chronic kidney disease is fluid retention and volume overload accompanied by retention of nitrogenous waste products and some electrolytes. Bowel fluid contains high levels of urea, creatinine, uric acid, and electrolytes, which make it a potential candidate for intestinal excretion of nitrogen wastes and electrolytes. Cross-linked polyelectrolyte (CLP) is a polymer that, given orally, absorbs excess fluid, electrolyte, and nitrogenous waste products...
July 2017: Iranian Journal of Kidney Diseases
https://www.readbyqxmd.com/read/28758978/dietary-approaches-in-the-management-of-diabetic-patients-with-kidney-disease
#20
REVIEW
Gang Jee Ko, Kamyar Kalantar-Zadeh, Jordi Goldstein-Fuchs, Connie M Rhee
Chronic kidney disease (CKD) is one of the most prevalent complications of diabetes, and patients with diabetic kidney disease (DKD) have a substantially higher risk of cardiovascular disease and death compared to their non-diabetic CKD counterparts. In addition to pharmacologic management strategies, nutritional and dietary interventions in DKD are an essential aspect of management with the potential for ameliorating kidney function decline and preventing the development of other end-organ complications. Among DKD patients with non-dialysis dependent CKD, expert panels recommend lower dietary protein intake of 0...
July 31, 2017: Nutrients
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