Abstract
In haemodialysis, sodium and fluid balance (where intake matches loss) is achieved by ultrafiltration and by diffusion between the plasma water and dialysate. If a patient’s sodium intake does not change, any reduction in fluid gain obtained by lowering dialysate sodium concentration will result in less sodium removal by ultrafiltration. The corresponding change in diffusion to achieve balance may mean the benefit of lower fluid gain is offset by morbidity caused by a fall in serum sodium during dialysis. The standard dialysate sodium should minimise harm caused by both high ultrafiltration rates and osmotic disequilibrium. For most units, this is likely to be 138 to 140 mmol/L.
Highlights
In haemodialysis, sodium and fluid balance is achieved by ultrafiltration and by diffusion between the plasma water and dialysate
The plasma water sodium concentration will equilibrate with the dialysate sodium concentration (DNa) by diffusion through the dialyser membrane
During a recent RCT from New Zeala associated with an increased risk of morbidity, including intradialytic hypotension (IDH), patients who converted to DNa 135 mmol/L from 140 mmol/L had more than three ti cramps, and longer recovery times
Summary
To maintain the same pre-dialysis SNa when DNa is reduced, patients must either increase their dietary sodium intake or decrease their fluid. During a recent RCT from New Zeala associated with an increased risk of morbidity, including intradialytic hypotension (IDH), patients who converted to DNa 135 mmol/L from 140 mmol/L had more than three ti cramps, and longer recovery times. 12-month follow-up rate be outweighed by osmotic disequilibrium This suggests the benefit of a lower ultrafiltration dialysis), which causes fluid to shift from extracellular to intracellular compartments, rate can be outweighed by osmotic disequilibrium (due to the fall in SNa during dialysis), creasing blood volume.
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