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Dialysate sodium and intradialytic hypotension
Author(s) -
Hussein Wael F.,
Schiller Brigitte
Publication year - 2017
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12634
Subject(s) - medicine , hemodialysis , dialysis , sodium , population , intensive care medicine , complication , ultrafiltration (renal) , chemistry , environmental health , organic chemistry , chromatography
Intradialytic hypotension ( IDH ) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain ( IDWG ), high ultrafiltration rates ( UFR ), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D‐Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG , UFR , and hypertension. On the other hand, high dialysate sodium is associated with more hemodynamic benefits in an unstable patient. The resulting sodium loading may, however, induce a vicious cycle of higher IDWG , requiring more rapid ultrafiltration, eventually contributing to intradialytic symptoms and hypotension. In this article, we review the available literature on fixed and profiled dialysate sodium prescriptions, and we recommend a tailored approach that considers the patient's status to optimize dialysis delivery.