SODIUM PROFILING IN ELDERLY HEMODIALYSIS-PATIENTS

Intradialytic vascular instability continues to be one of the most fre quent complications in elderly haemodialysis patients. Signs of impend ing hypotension such as sweating, apprehension, tachycardia, nausea, o r vomiting may be infrequent in the geriatric population. The onset of hypotension in the elderly may be sudden and profound and may lead to serious consequences such as myocardial infarction, stroke, or aspira tion if not treated promptly. Prevention of vascular instability is ex tremely important in the elderly. Avoiding rapid ultrafiltration, seda tives, or antihypertensive medications and food intake may be benefici al. Optimal dialysate composition (dialysate sodium, bicarbonate, and calcium concentration) is important. Dialysate sodium profiling may be useful in the elderly to reduce intradialytic hypotension. Step sodiu m profiles result in better plasma volume refilling in early dialysis, while linear dialysate sodium profiles have greater plasma volume in late dialysis, suggesting that dialysate sodium profiles may need to b e individualized for optimal response. Sodium profiling could also res ult in sodium retention, and long-term studies are needed in the elder ly before their widespread use is recommended. Use of newer modalities such as continuous monitoring of plasma volume with Grit Line, and de termination and monitoring of body-fluid compartments with bioimpedanc e may further improve vascular stability in the elderly.