«Physiological» and «Pharmacological» Dialysate Sodium Concentrations

Abstract

Forty three uremic patients on regular hemodialysis treatment (4 hours 3 times/week) were dialyzed for a period of 28.95 ± 14.46 months with a dialysate sodium concentration (NaD) of 142 mEq/l, similar to their plasma water sodium concentration corrected for the Donnan factor («physiological» NaD). Blood pressure (BP) and body weight (BW) dropped significantly. During two following periods, lasting 18 and 14 months, with NaD 148 mEq/l, similar to the patients’ plasma water sodium concentration («pharmacologically high» NaD), cardiovascular stability improved and BP did not show significant increase. Using «physiological» and «pharmacologically high» NaD the removal of water and sodium by convection improves the cardiovascular stability and the patients’ well being, without bringing about the feared long-term cardiovascular side effects, if an appropriate dry body weight is achieved, because of better correction of the cellular overhydration.