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Sodium balance in maintenance hemodialysis
Sergio F F Santos1, Aldo J Peixoto
1Division of Nephrology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. aldo.peixoto@yale.edu
Seminars in Dialysis
|December 24, 2010
Summary
Chronic hemodialysis (HD) patients maintain fluid balance through diet and dialysis. Optimizing dialysate sodium concentration based on pre-dialysis serum sodium is key for managing fluid balance and preventing complications like hypertension.
Area of Science:
- Nephrology
- Physiology
- Dialysis Therapy
Background:
- Maintaining extracellular fluid volume is crucial for chronic hemodialysis (HD) patients.
- Fluid balance is governed by interdialytic salt intake and sodium removal during HD sessions.
- Sodium removal primarily occurs via ultrafiltration, with diffusion fine-tuning the balance.
Purpose of the Study:
- To explore the role of serum sodium concentration in managing fluid balance during chronic hemodialysis.
- To investigate the impact of dialysate-to-plasma sodium gradient on patient outcomes.
- To discuss novel insights into nonosmolar interstitial sodium storage.
Main Methods:
- Analysis of pre-dialysis serum sodium levels in HD patients.
- Review of sodium removal mechanisms during hemodialysis (ultrafiltration and diffusion).
- Examination of the relationship between dialysate sodium and patient fluid status.
Main Results:
- HD patients exhibit a stable, individual osmolar set point, indicated by minimal pre-HD serum sodium variation.
- A positive dialysate-to-plasma sodium gradient correlates with increased thirst, interdialytic weight gain, and hypertension.
- Isonatric HD requires dialysate sodium to match patient serum sodium, with convective removal of interdialytic sodium gains.
Conclusions:
- Pre-HD serum sodium concentration serves as a reliable reference for prescribing dialysate sodium in chronic HD.
- Adjusting dialysate sodium can optimize fluid balance and mitigate adverse effects in HD patients.
- Further research into nonosmolar interstitial sodium storage may offer new therapeutic strategies.
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