Blood Volume Change and Side Effects during Various Sodium Ramping in Hemodialysis
다양한 고염투석액을 이용한 혈액투석시 혈액량의 변화 및 부작용 발생의 관찰
Ma, KA; Kim, HS; Kim, MS; Kim, SJ; Jeong, CG; Kim, HJ; Ko, KH; Kim, SD; Ji, SB; Shin, GT; Kim, DH
Taehan Sinjang Hakhoe chi, 18(3):436-444, 1999
Taehan Sinjang Hakhoe chi; The Korean journal of nephrology; 대한신장학회지
Chronic hemodialysis patients frequently experience hemodialysis(HD)-related side
effects caused by excessive ultrafiltration and abrupt change of osmolality. Sodium
ramping in HD is known to reduce ultrafiltration-related side effects, but it frequently induces symptoms related to sodium overload. We wanted to know the relationship between blood volume changes and the side effects related to ultra-filtration during hemodialysis and whether we can individualize various sodium ramping methods according to the effect of change in blood volume(BV) and side effects of sodium
ramping. We studied 9 hypotension-prone patients during HD. The duration of the study lasted (or 5 weeks, each week using different sodium ramping protocols: protocol 1; dialysate [Na+] of 140mEq/L, protocol 2; dialysate [Na+] same as the predialysis seam [Na+], protocol 3; dialysate [Na+] was 20mEq/L greater than that of the patient's serum for 1hr, 10mEq/L greater than patient's serum [Na+] for 2hr and den the same as patient's serum [Na+] for the last 1hr, protocol 4; at the beginning of
dialysis, dialysate sodium was ramped to 20mEq/L above the patient's seam sodium and
then on a straight linear fashion lowered to the predialysis serum [Na+] at the end of dialysis, protocol 5; sodium was constantly ramped to 10 mEq/L above serum [Na+]. We measured the △BV with Crit-Line IIR(In-Line Diagnostics, Corp., Riverdale, USA), the blood Pressure during each HD and interdialytic weight gain.
We documented subjective symptoms which occurred during the 5 treatment protocols
by patient's questionnaire after each HD.
The results were as follows.
1) The mean age of the patients(M : F=3 : 6) was 54.1 years and 6 patiens were diabetics.
2) There was no significant difference in the △BV among the 5 protocols in both
whole study population and individual. Neither was there a statistically signigicant difference in the △BV with respect to hypotension during HD.
3) There were no episodes of hypotension(P value <0.001) with protocols 3, 4, 5
compared to protocols 1 and 2.
4) Three patients during protocols 4 and 5 experienced more thirst after HD than
during protocol 1 and one Patient during protocol 4, 5 had more interdialytic weight gain than the protocol 1. As a whole, patients while on protocol 4 & 5 experienced more thirst than protocol 1 but patients during protocol 3 experienced the same degree of thirst as protocol 1.
In summary, sodium ramping reduced HD-related side effects but this benefit could
not be explained on the basis of blood volume change measured by the Crit-Line IIR.
protocol 3 may be more appropiate sodium ramping method in 4 of the 9 patients. These
data suggest that protocol 3 may be used before protocol 4, 5 when we apply sodium
ramping to the patients who frequently have hypotension during HD.
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