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Sodium and water profiling in chronic uraemia
1Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Summary
Haemodialysis side effects like hypotension may be linked to fluid shifts, not dehydration. Patient-specific sodium profiles during dialysis may reduce symptoms, but more research is needed.
Area of Science:
- Nephrology
- Clinical Medicine
Background:
- Haemodialysis (HD) commonly causes side effects.
- Hypotension and cramps are linked to intravascular volume depletion.
- Headache and fatigue are linked to osmolality changes.
Purpose of the Study:
- To evaluate hypotheses linking HD side effects to volume and osmolality changes.
- To systematically review evidence on HD-induced morbidity.
- To assess the impact of sodium profiling on patient symptoms.
Main Methods:
- Evidence-based systematic review of English language literature.
- Analysis of studies on intravascular volume changes during HD.
- Evaluation of studies on osmolality changes and sodium profiling.
Main Results:
- Overhydration may protect against hypotension during HD, but risks heart failure.
- Changes in hematocrit reflect vascular volume and can predict hypotension.
- Sodium profiling showed potential benefit in reducing intradialytic symptoms in some studies.
Conclusions:
- Intravascular volume and osmolality changes are implicated in HD side effects.
- Sodium profiling may alleviate patient symptoms during haemodialysis.
- Further randomized, blinded studies are required to confirm the impact of sodium/ultrafiltration modeling.