Sequential sodium therapy allows correction of sodium-volume balance and reduces morbidity.

Abstract

We investigated whether individually adjusting Na+ dialysis levels (Na+Di) combined with Na+ and UFR (ultrafiltration rate) programming, and a sodium/volume model (sequential sodium therapy, SST) can improve the end stage renal failure (ESRD) patient's homeostatic equilibrium intra- and interdialytically. One hundred and fifty patients were included in the study over a one year period. The results show that the patients are divided into two groups: 50 patients respond according to the sodium/volume model developed by F. Gotch [1983]. In this group it is possible to predict pre- and post dialysis plasma Na+ concentration (Na+o, Na+t) as a function of Na+Di and it becomes possible to choose Na+Di to allow Na+o and Na+t to virtually coincide, eliminating severe shifts in plasma tonicity. In the second group two subgroups can be distinguished: excess Na+ or excess H2O post dialysis, without possible correction at a single sodium level. SST corrects sodium/volume balance in this group by using sequential intermittent hypo or hypertonic dialysate, combined with fluid removal adapted to each episode. In both groups there was a significant improvement in the clinical condition of the patients who previously were less equilibrated. It is possible to conclude that SST improves tolerance intradialytically and achieves better equilibrium interdialytically. Implementation of SST requires precise control of the concentrate and the water, and equipment adapted for accurate, programmable sequential control of Na+Di and ultrafiltration rate.