Study on sodium and potassium balance during hemodialysis

To acquire data for adequate ultrafiltration (UF) control, sodium and potassium balance was investigated during hemodialysis (HD) in 16 hemodialyzed patients. Overall balances were evaluated from concentration measurements of the in- and outflowing dialysate and pre- and postdialysis plasma. The diffusive and convective part of the electrolyte removal and its intra- and extracellular space (ICS, ECS) component were calculated. During a 5-h HD, 40-110 mmol of potassium is removed, predominantly by diffusion (72-88%). Calculation shows that 40-70% of the removed amount is taken from the ICS. Sodium's overall HD showed much higher scatter, ranging from positive values to 500 mmol removal. The diffusive component was positive in most cases. By ultrafiltration sodium is removed in all cases. Calculations also showed in all cases that sodium was delivered to the ICS. This is in contradiction with the general belief that exchangeable sodium is distributed solely in ECS (1,2,6,7). This may be a sign of the effort to keep changes of ICS osmotic load at a minimum. Based on the finding of the exchange of sodium for potassium in the cellular wall, a method has been devised to calculate the UF fraction removed from EC (UFEC) expressed as a coefficient KEC = UFEC/UFToT, with UFToT being the total fluid volume removed during the HD session.