Abstract
Restoring sodium and fluid homeostasis in hemodialysis (HD) patients is a crucial aim to reduce cardiovascular burden and improve global outcome. This crucial target is achieved at maximum in one quarter of HD patients according to a recent study. Sodium and fluid balance relies on a multitarget approach involving dietary salt restriction, dialysis salt mass removal and eventually residual kidney function. Salt mass removal in hemodialysis relies on ultrafiltration (convective sodium), the dialysate–plasma sodium gradient (diffusive sodium) and total treatment time. Manual dialysate sodium prescription has three major aims: dialysate–plasma sodium gradient; sodium mass removal target; hemodialysis tolerance and patient risks. In the future, automated dialysate sodium adjustment by HD machine will facilitate this aim.
Highlights
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Salt mass removal in hemodialysis relies on three components: firstly, convective sodium flux dragged isotonically through ultrafiltration; secondly, diffusive sodium flux driven by the dialysate–plasma sodium gradient and flow conditions [7]; thirdly, treatment time, which integrates sodium fluxes and conditions, the total salt mass removed per session [8]
Manual dialysate sodium prescription should be based on three major components: firstly, the dialysate–plasma sodium gradient; secondly, the sodium mass removal target; thirdly, hemodialysis tolerance and patient risks
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dialysate Sodium Prescription from a Personal Clinician Perspective Sodium and fluid balance in dialysis patients relies on a multitarget approach involving dietary salt restriction, dialysis salt mass removal and eventually residual kidney function [4,6].
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