Sodium Prescription in the Prevention of Intradialytic Hypotension: New Insights into an Old Concept

Abstract

Background: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist, as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium levels.

Methods: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller.

Results: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis (HD) and discusses 2 strategies to remove excess sodium in patients prone to intradialytic hypotension, namely, Profiled HD and the hemodiafiltration Aequilibrium System.

Conclusion: The Profiled HD and Aequilibrium System trial both proved effective in counteracting intradialytic hypotension.

Keywords: Hemodialysis; Intradialytic hypotension; Sodium mass balance; Techniques.