Sodium and fluid modulation in dialysis: New approach

Hypotension during hemodialysis is still an unsolved problem. The treatment of patients with cardiovascular instability is efficaciously carried outwi th the use of 'profiled dialysis' (PD) with computerized modulation of ultr afiltration and conductivity. We tested a new profile model which involves progressive decrease of ultrafiltration associated with variable conductivi ty ('bell pattern'). We observed 8 stable long-term patients receiving hemo dialysis (4 men and 4 women, mean age 63.5 years) for 4 h three times a wee k. Before our test, sodium balance had reached a steady state in all patien ts and remained stable during the entire observation period. The sodium bal ance was established by means of a simple pattern suggested by Ursino and c oworkers. The patients were observed for two periods of 1 month each (proto cols A and B). The intradialytic mean arterial pressure was studied, checki ng every hour of dialysis. Statistical analysis was done by ANOVA for repea ted measures. We compared standard dialysis with constant ultrafiltration r ate and conductivity (protocol A) with sessions performed involving a progr essive decrease of ultrafiltration together with a variable conductivity of -0.2, +0.2, +0.6, +0.6, 0, -0.4, -0.4, and -0.4 mS/s (protocol B). We foun d a lower incidence of hypotension (p < 0.01) with better cardiovascular st ability during and after treatment in 'profiled dialysis'. Copyright (C) 20 01 S. Karger AG, Basel.