Online Conductivity Monitoring: Validation and Usefulness in a Clinical Trial of Reduced Dialysate Conductivity

Relatively low dialysate conductivity (Cndi) may improve outcomes by reducing the overall sodium burden in dialysis patients. Excess sodium removal, however, could lead to hemodynamic instability. We performed a randomized controlled trial of reduction of Cndi. For the study, 28 patients were randomized to maintenance of Cndi at 13.6 mS/cm (equivalent to 135 mmol/L of Na+) or serial reduction of Cndi in steps of 0.2 mS/cm, guided by symptoms and blood pressure. Sodium removal estimated from pre- and postplasma concentrations correlated well with removal measured by conductivity monitoring as ionic mass balance (R2 0.66, p < 0.0001). Of the 16 patients randomized to reduction of Cndi, 6 achieved Cndi 13.4 mS/cm, 6 achieved 13.2 mS/cm, and 4 achieved 13.0 mS/cm. No episodes of disequilibrium occurred. Interdialytic weight gain was reduced from 2.34 ± 0.10 kg to 1.57 ± 0.11 kg (p < 0.0001). Predialysis systolic blood pressure fell from 144 ± 3 mm Hg to 137 ± 4 mm Hg (p < 0.05). The reduction in convective sodium removal was balanced by an increase in diffusive sodium removal (95 ± 9 mmol cf. 175 ± 14 mmol, p < 0.0001). Reduction in Cndi monitored by IMB is safe and practical and leads to improved interdialytic weight gains and blood pressure control, while avoiding excessive sodium removal.

[1]  S. Santos,et al.  Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. , 2004, Kidney international.

[2]  S. Fukuhara,et al.  Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. , 2003, Kidney international.

[3]  K. Leunissen,et al.  Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration. , 2002, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  C. Tomson,et al.  Advising dialysis patients to restrict fluid intake without restricting sodium intake is not based on evidence and is a waste of time. , 2001, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[5]  P. Kimmel,et al.  Interdialytic weight gain and survival in hemodialysis patients: effects of duration of ESRD and diabetes mellitus. , 2000, Kidney international.

[6]  T. Petitclerc,et al.  Festschrift for Professor Claude Jacobs. Recent developments in conductivity monitoring of haemodialysis session. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[7]  B. Béné,et al.  Sodium management in dialysis by conductivity. , 1999, Advances in renal replacement therapy.

[8]  G. Russell,et al.  Sudden and cardiac death rates in hemodialysis patients. , 1999, Kidney international.

[9]  G. Murata,et al.  Estimates of Interdialytic Sodium and Water Intake Based on the Balance Principle: Differences Between Nondiabetic and Diabetic Subjects on Hemodialysis , 1998, ASAIO journal.

[10]  B. Scribner,et al.  Blood pressure control in dialysis patients: importance of the lag phenomenon. , 1998, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[11]  F. Akçiçek,et al.  Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[12]  K. Koch,et al.  Dietary salt restriction and reduction of dialysate sodium to control hypertension in maintenance haemodialysis patients. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  F. Fabbian,et al.  Interdialytic weight gain and 48-h blood pressure in haemodialysis patients. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[14]  F. Locatelli,et al.  Monitoring Sodium Removal and Delivered Dialysis by Conductivity , 1995, The International journal of artificial organs.

[15]  R. Atkins,et al.  Kt/V in CAPD by different estimations of V. , 1995, Kidney international.

[16]  T. Petitclerc,et al.  Dialysis sodium concentration: what is optimal and can it be individualized? , 1995, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[17]  M. Jaudon,et al.  Non-invasive monitoring of effective dialysis dose delivered to the haemodialysis patient. , 1995, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[18]  L. Lins,et al.  Acute symptoms during and between hemodialysis: the relative role of speed, duration, and biocompatibility of dialysis. , 1994, Artificial organs.

[19]  Polaschegg Hd,et al.  Automatic, noninvasive intradialytic clearance measurement. , 1993 .

[20]  D. Hollomby,et al.  Effects of high sodium dialysate during maintenance hemodialysis. , 1985, Nephron.

[21]  R. Wilkinson,et al.  Cramps, thirst and hypertension in hemodialysis patients -- the influence of dialyzate sodium concentration. , 1977, Clinical nephrology.

[22]  W. J. Johnson,et al.  Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate. , 1973, Kidney international.

[23]  F. M. van der Sande,et al.  Preventing dialysis hypotension: a comparison of usual protective maneuvers. , 2001, Kidney international.

[24]  H. Mann,et al.  Sodium modeling. , 2000, Kidney international. Supplement.

[25]  S. Somiah,et al.  Quenching the thirst in dialysis patients. , 1996, Nephron.

[26]  T. Babazono,et al.  Current status of renal replacement therapy in Japan. , 1995, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[27]  F. Gotch,et al.  Preliminary clinical results with sodium-volume modeling of hemodialysis therapy. , 1980, Proceedings of the Clinical Dialysis and Transplant Forum.

[28]  S. Massry,et al.  Clinical aspects of uremia and dialysis , 1976 .