Why does the choice of dialysate sodium concentration remain controversial?

Abstract The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration. Although most studies have reported a reduction in IDWG with lower dialysate sodium concentrations, the effects on blood pressure control, and adverse intradialytic events have been variable. Different outcomes between studies may be partially explained by patient selection, with differences in dietary sodium intake, urinary sodium losses, and sodium stores in the body. In addition, multicenter trials potentially introduce additional confounders, including differences in local quality control of delivered dialysate sodium concentration and sodium measurements. Although there may be advantages for lower dialysate sodium concentration, observational studies have reported a survival advantage for higher dialysate sodium concentrations for those patients with lower serum sodium concentrations pre‐dialysis. As there is no current consensus for a universal dialysate sodium concentration, at...
Source: Hemodialysis International - Category: Hematology Authors: Tags: Review Article Source Type: research

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AbstractSpontaneous native kidney rupture (SNKR) is a rare occurrence, commonly associated with underlying renal tumors or acquired renal cystic disease in both the kidney transplant (KT) and non-KT populations. Herein, we present a 65-year-old African American man who experienced a non-malignant SNKR 6  days after a deceased donor KT and underwent emergent native nephrectomy. The patient’s hospital course was complicated by thrombocytopenia and refractory hypertension. He experienced delayed graft function and was maintained on hemodialysis until post-operative day 30. This case demonstrates an unusual presenta...
Source: CEN Case Reports - Category: Urology & Nephrology Source Type: research
ConclusionThe atypical hemolytic uremic syndrome is a rare disease entity requiring a high index of suspicion to diagnose. It is a diagnosis of exclusion. Early diagnosis with prompt treatment will render a better outcome. The atypical hemolytic uremic syndrome needs to be considered in all patients with thrombotic microangiopathy.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Authors: Toroghi HM, Lo KB, Ziccardi MR, Horn B, Kanjanahattakij N, Malik E, Penalver J, Rangaswami J, Gupta S, Amanullah A Abstract Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capac...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
We report our care of a 48-year-old woman suffering from right heart failure and massive fluid overload due to severe pulmonary hypertension secondary to a combination of left-heart disease and status after recurrent pulmonary embolisms. Alterations in Doppler-derived intrarenal venous flow patterns and a novel renal venous stasis index were used to evaluate improvement in renal venous congestion during recompensation. Due to refractory congestion despite optimal medical treatment and continuous veno-venous hemodialysis, a peritoneal dialysis catheter was placed to relieve the massive ascites. The paracentesis of ascites l...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
Conclusion: The use of individualized dialysate sodium level is safe and results in lower IDWG, pre-HD systolic BP, and intradialytic hypertension in patients on HD.
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
ConclusionIn addition to classical and predictable abnormalities related to the the uremic condition such as myocardial hypertrophy, we found a high prevalence of dilatation of the ascending aorta. Some associated factors are highlighted.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Authors: Morovatdar N, Tayebi Nasrabad G, Tsarouhas K, Rezaee R Abstract Introduction: End-stage renal disease (ESRD) is one of the most common life-threatening diseases. In the past two decades, several factors were held responsible as the cause of this condition. The present study aimed to determine the causes of ESRD in the province of Khorasan Razavi, Iran. Materials and Methods: This cross-sectional study was conducted on 2404 ESRD patients who referred to 39 hemodialysis centers in Khorasan Razavi province, Iran, and were registered in the Mashhad University of Medical Sciences (MUMS), between 2000 and De...
Source: International Journal of Nephrology - Category: Urology & Nephrology Tags: Int J Nephrol Source Type: research
CONCLUSION: Although multiple organ systems are commonly affected in hemolytic uremic syndrome, ocular involvement has only been described in very few cases. Ocular manifestations in atypical hemolytic uremic syndrome include retinal, choroidal and vitreal hemorrhages, retina and/or ischemic signs. Bilateral serous retinal detachment may also be a sign of atypical hemolytic uremic syndrome or even the first manifestation of a hypertensive event. PMID: 31875682 [PubMed - as supplied by publisher]
Source: European Journal of Ophthalmology - Category: Opthalmology Authors: Tags: Eur J Ophthalmol Source Type: research
We report a case of a 30-year-old female patient referred to our clinic with a chief complaint of a painful swelling of the left mandible and difficulty chewing. Her medical history included systemic lupus erythematosus, hypertension, and chronic kidney disease (was on hemodialysis for the past 9 years).
Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics - Category: ENT & OMF Authors: Source Type: research
This study suggests the role of DQ antibodies in determining the graft survival and to highlight the need of HLA DQ typing as a routine of the diagnostic work-up in a solid organ transplant.
Source: Asian Journal of Transfusion Science - Category: Hematology Authors: Source Type: research
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