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2017 ; 30
(2
): 99-111
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Dialysate Sodium: Rationale for Evolution over Time
#MMPMID28066913
Flythe JE
; Mc Causland FR
Semin Dial
2017[Mar]; 30
(2
): 99-111
PMID28066913
show ga
Oligo-anuric individuals receiving hemodialysis (HD) are dependent on the
dialysis machine to regulate sodium and water balance. Interest in adjusting the
dialysate sodium concentration to promote tolerance of the HD procedure dates
back to the early years of dialysis therapy. Evolution of dialysis equipment
technologies and clinical characteristics of the dialysis population have
prompted clinicians to increase the dialysate sodium concentration over time.
Higher dialysate sodium concentrations generally promote hemodynamic
stabilization and reduce intradialytic symptoms but often do so at the expense of
stimulating thirst and promoting volume expansion. The opposite may be true for
lower dialysate sodium concentrations. Observational data suggest that the
association between dialysate sodium and outcomes may differ by serum sodium
levels, supporting the trend toward individualization of the dialysate sodium
prescription. However, lack of randomized controlled clinical trial data, along
with operational safety concerns related to individualized dialysate sodium
prescriptions, have prevented expert consensus regarding the optimal approach to
the dialysate sodium prescription.
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