OPTIMIZATION OF SODIUM REMOVAL IN PAIRED FILTRATION DIALYSIS BY SINGLE POOL SODIUM AND CONDUCTIVITY KINETIC-MODELS

Sodium removal is one of the main factors affecting intradialytic card iovascular stability and interdialytic hypertension, and its removal s hould therefore be individualized, The aims of this study were: (1) to test the ability of a single-pool variable volume (SPVV) sodium kinet ic model (NaKM) to optimize sodium removal in paired filtration dialys is (PFD), and (2) to test a SPW conductivity kinetic model (CKM) in or der to verify whether CKM can be used as an alternative for NaKM in es timating sodium balance, The mean difference between the NaKM-predicte d and measured end-PFD plasma water ionized sodium concentrations was 0.00 +/- 0.55 mEq/l, which means that the model has an imprecision of less than or equal to 1.1 mEq/l. The mean difference between predicted and measured sodium removal was 0.21 +/- 16.86 mEq/session, which mea ns a model overestimate of 0.21 mEq/session. The mean difference betwe en the CKM-predicted and measured end-PFD ultra-filtrate conductivity was 0.01 +/- 0.05 mS/cm, which means an inaccuracy of the model of 0.0 1 mS/cm and an imprecision of less than or equal to 0.1 mS/cm. The reg ression in the ionized sodium concentration measured in plasma or bloo d oil the conductive values of the ultrafiltrate shows an error of les s than or equal to 2 mEq/l in the prediction of the ionized sodium con centration in blood by means of ultrafiltrate conductivity measurement s, These results demonstrate that both models make it possible to obta in a level of dialytic sodium removal that is almost equivalent to int erdialytic sodium loading. Moreover, gives that it does not require bl ood sampling and the possibility of making repeated and inexpensive ul trafiltrate conductivity measurements, the CKM allows online monitorin g of programmed sodium removal.