AN ALGORITHM FOR THE RATIONAL CHOICE OF SODIUM PROFILE DURING HEMODIALYSIS

The incidence of intradialytic disequilibrium syndrome and symptomatic hypotension has increased significantly among dialysis patients over the last ten years. Profiled hemodialysis (PHD) is a new technique, ba sed on the intradialytic modulation of dialysate sodium concentration, which aspires to reduce to previous imbalances. This paper presents a new algorithm for the determination of a rational dialysate sodium pr ofile during PHD. A mathematical model of solute kinetics, monocompart mental for sodium and bicompartmental for urea is used. The algorithm allows the sodium profile to be elaborated a priori before each dialys is session, respecting the individual sodium mass removal and weight g ain. A procedure allowing the adjustment of the method to the individu al characteristics, on the basis of routine measurements performed bef ore each session is also presented.The method was validated during sev en dialysis sessions. Comparison between data measured in vivo and tho se predicted by the model showed standard deviations corresponding to the range of laboratory measurement errors: 1.50 mEq/L for sodium and 0.87 mmol/L for urea. In vivo implementation of PHD by our algorithm a llows one to remove an amount of sodium close to that established a pr iori on the basis of patient's need.