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Monitoring sodium removal and delivered dialysis by conductivity
F Locatelli1, S Di Filippo, C Manzoni
1Department of Nephrology, Ospedale di Lecco, Italy.
Insights
This study shows that conductivity kinetic modeling (CKM) accurately monitors dialysis fluid removal without blood samples. The Biofeedback Module (BM) enables precise control of dialysis, improving patient outcomes.
Area of Science:
- Nephrology
- Biomedical Engineering
- Medical Devices
Background:
- Hemodialysis patient outcomes depend on cardiovascular stability and dialysis dose.
- Accurate monitoring of fluid and electrolyte removal is crucial for hemodialysis.
- Current methods may require invasive procedures like blood sampling.
Purpose of the Study:
- To evaluate the Biofeedback Module (BM) for automatic monitoring of hemodialysis.
- To assess the validity of conductivity kinetic modeling (CKM) as a substitute for sodium kinetic modeling.
- To investigate the in vivo relationship between ionic dialysance and urea clearance.
Main Methods:
- Utilized a Biofeedback Module (BM--COT Hospal) for real-time measurement of plasma water conductivity and ionic dialysance.
- Employed conductivity kinetic modeling (CKM) to predict end-dialysis conductivity.
- Compared ionic dialysance with effective urea clearance.
Main Results:
- CKM achieved programmed end-dialysis plasma water conductivity within +/- 0.14 mS/cm (approx. +/- 1.4 mEq/L sodium).
- Ionic dialysance and effective urea clearance were found to be non-equivalent.
- The BM facilitates routine monitoring of delivered dialysis by understanding the relationship between ionic dialysance and urea clearance.
Conclusions:
- CKM is a valid method for monitoring and controlling hemodialysis fluid removal.
- The BM offers a non-invasive approach to assess dialysis effectiveness.
- Routine monitoring of delivered dialysis is feasible with the BM, enhancing patient care.
Abstract:
As cardiovascular stability and the delivery of the prescribed dialysis "dose" seem to be the main factors in determining the morbidity and mortality of hemodialyzer patients today, it is of paramount importance to match hydro-sodium removal with interdialytic load and to verify the delivered dialysis at each session. A specially designed Biofeedback Module (BM--COT Hospal) allows the automatic determination of plasma water conductivity and effective ionic dialysance with no need for blood samples. Using BM, we evaluated the validity of "conductivity kinetic modelling" (CKM) and the possibility that this may substitute "sodium kinetic modelling". Moreover, we evaluated the "in vivo" relationship between ionic dialysance and effective urea clearance. Our results demonstrate that: 1) CKM makes it possible to obtain programmed end-dialysis plasma water conductivity with an error of less than +/- 0.14 mS/cm, roughly equivalent to a sodium concentration of +/- 1.4 mEq/L. 2). Ionic dialysance and effective urea clearance are not equivalent but, as the interrelationship between these is known, the BM allows the routine monitoring of delivered dialysis.